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Organization
SPARTAN ORTHOPAEDICS, LLC
Active
Organization
SPARTAN ORTHOPAEDICS, LLC
Active
Parent organization
SPARTAN ORTHOPAEDICS, LLC
Other names
Champion Orthopaedics, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
SPARTAN ORTHOPAEDICS, LLC
Authorized official
JENNIFER C BULLOCK (PRESIDENT)
(662) 534-2298
Entity
Organization
Contact information
Practice address
6518 GOODMAN RD STE 104, OLIVE BRANCH, MS 38654-9809
(662) 420-7350
(662) 932-3010
Mailing address
6518 GOODMAN RD STE 104, OLIVE BRANCH, MS 38654-9809
(662) 420-7350
(662) 932-3010
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02654844
—
MS
05
—
200025185
—
MS
01
—
512G700048
MEDICARE PTAN
MS
01
—
6131110004
MEDICARE DME PTAN
MS
Enumeration date
09/15/2015
Last updated
07/28/2026
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