Organization
MISSISSIPPI ORTHOPAEDIC INSTITUTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT LANCE JOHANSEN MD (OWNER)
(228) 328-2400
Entity
Organization
Contact information
Practice address
15190 COMMUNITY RD STE 120, GULFPORT, MS 39503-3484
(228) 328-2400
(228) 328-4200
Mailing address
15190 COMMUNITY RD SUITE 120, GULFPORT, MS 39503
(228) 328-2400
(228) 328-4200
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
14698
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04232510
—
MS
Enumeration date
09/19/2013
Last updated
09/19/2013
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