# MID STATE ORTHOPAEDIC & SPORTS MEDICINE CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MID STATE ORTHOPAEDIC & SPORTS MEDICINE CENTER LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1447707583
- **Legal business name:** MID STATE ORTHOPAEDIC & SPORTS MEDICINE CENTER LLC
- **Authorized official:** MARK DODSON M.D. (PRESIDENT)
- **Authorized official phone:** (318) 473-9556

## Contact information

- **Practice address:** 504 JACK MILLER ROAD, VILLEPLATTE, LA 70586
- **Practice address phone:** (318) 473-9556
- **Practice address fax:** (318) 484-6032
- **Mailing address:** 3444 MASONIC DRIVE, ALEXANDRIA, LA 71301
- **Mailing address phone:** (318) 473-9556
- **Mailing address fax:** (318) 484-6032

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | 9317843 | LA | Yes |

## Other

- **Enumeration date:** 09/07/2016
- **Last updated:** 04/26/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 1946320 | — | LA |
| 01 | — | CD7720 | RAILROAD MEDICARE | LA |