Organization
SPARTAN ORTHOPAEDICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER C BULLOCK (PRESIDENT)
(662) 534-2298
Entity
Organization
Contact information
Practice address
206 OXFORD RD, NEW ALBANY, MS 38652
(662) 534-2227
(662) 534-2330
Mailing address
PO BOX 15580, BELFAST, ME 04915-4050
(662) 534-2227
(662) 534-2330
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
213E00000X
Podiatrist
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002654844
—
MS
05
—
200025185
—
MS
Enumeration date
10/04/2007
Last updated
03/10/2026
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