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Organization
MID STATE ORTHOPAEDIC & SPORTS MEDICINE CENTER LLC
Active
Organization
MID STATE ORTHOPAEDIC & SPORTS MEDICINE CENTER LLC
Active
Parent organization
MIDSTATE ORTHOPAEDIC & SPORTS CENTER
Organization subpart
Yes
Provider details
NPI number
Legal business name
MIDSTATE ORTHOPAEDIC & SPORTS CENTER
Authorized official
MARK DODSON M.D. (PRESIDENT)
(318) 473-9556
Entity
Organization
Contact information
Practice address
601 W LAFAYETTE ST, WINNFIELD, LA 71483-3451
(318) 473-9556
(318) 484-6032
Mailing address
3444 MASONIC DR, ALEXANDRIA, LA 71301-3615
(318) 473-9556
(318) 484-6032
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
9317843
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1946320
—
LA
01
—
CD7720
RAILROAD MEDICARE
LA
Enumeration date
09/26/2016
Last updated
04/26/2021
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