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Organization
MID STATE ORTHOPAEDIC & SPORTS MEDICINE CENTER LLC
Active
Organization
MID STATE ORTHOPAEDIC & SPORTS MEDICINE CENTER LLC
Active
Parent organization
MID STATE ORTHOPAEDIC & SPORTS MEDICINE CENTER LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MID STATE ORTHOPAEDIC & SPORTS MEDICINE CENTER LLC
Authorized official
MARK DODSON M.D. (PRESIDENT)
(318) 473-9556
Entity
Organization
Contact information
Practice address
504 JACK MILLER ROAD, VILLEPLATTE, LA 70586
(318) 473-9556
(318) 484-6032
Mailing address
3444 MASONIC DRIVE, ALEXANDRIA, LA 71301
(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
09/07/2016
Last updated
04/26/2021
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