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Organization
MID STATE ORTHOPAEDICS & SPORTS MEDICINE CENTER LLC
Active
Organization
MID STATE ORTHOPAEDICS & SPORTS MEDICINE CENTER LLC
Active
Parent organization
MID STATE ORTHOPAEDICS & SPORTS MEDICINE CENTER LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MID STATE ORTHOPAEDICS & SPORTS MEDICINE CENTER LLC
Authorized official
MARK DODSON M.D. (PRESIDENT)
(318) 473-9556
Entity
Organization
Contact information
Practice address
5541 HWY 1, MARKSVILLE, LA 71351-2650
(318) 473-9556
(318) 484-6032
Mailing address
3444 MASONIC DRIVE, ALEXANDRIA, LA 71301-3615
(318) 473-9556
(318) 484-6032
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
NULL
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0570570001
MEDICARE DME
LA
05
—
1946320
—
LA
Enumeration date
09/01/2016
Last updated
04/26/2021
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