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 A DODSON M.D. (PRESIDENT)
(318) 473-9556
Entity
Organization
Contact information
Practice address
155 NINTH ST, STE A, JENA, LA 71342-3900
(318) 473-9556
(318) 441-8339
Mailing address
3444 MASONIC DR, ALEXANDRIA, LA 71301-3615
(318) 473-9556
(318) 441-8339
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
9317843
LA
208100000X
Physical Medicine & Rehabilitation Physician
9317843
LA
Other
Enumeration date
08/09/2016
Last updated
04/26/2021
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