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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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