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Organization
LAUREL BONE AND JOINT CLINIC, PA
Active
Organization
LAUREL BONE AND JOINT CLINIC, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS R BICKER (CLINIC MANAGER)
(601) 649-5990
Entity
Organization
Contact information
Practice address
424 S 13TH AVE, LAUREL, MS 39440-4345
(601) 649-5990
(601) 425-7510
Mailing address
424 S 13TH AVE, LAUREL, MS 39440-4345
(601) 649-5990
(601) 425-7510
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0410450001
CIGNA GOVERNMENT SERVICES
MS
05
—
9011200
—
MS
01
—
CM7960
PALMETTO GBA-RAILROAD MEDICARE
MS
Enumeration date
11/02/2006
Last updated
11/02/2010
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