Mid State Orthopaedic & Sports Medicine Center LLC

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

9317843 Issued in LA

Legal business name

MID STATE ORTHOPAEDIC & SPORTS MEDICINE CENTER LLC

Practice address

429 Rocky Bayou Drive
Pineville, LA 71360

Phone

(318) 473-9556

Fax

(318) 484-6032

NPI assigned

Sep 7, 2016

Organization subpart

Yes

Parent organization

MIDSTATE ORTHOPAEDIC & SPORTS CENTERAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mark Dodson, M.D.

Title

Billing Manager

Phone

(318) 473-9556

Specialties & licenses 1

Addresses

Other identifiers 2

Part of

Mid State Orthopaedic a

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1473206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595203200000",
    "number": "1093262123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3444 MASONIC DRIVE",
            "city": "ALEXANDRIA",
            "state": "LA",
            "postal_code": "71301",
            "telephone_number": "318-473-9556",
            "fax_number": "318-484-6032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "429 ROCKY BAYOU DRIVE",
            "city": "PINEVILLE",
            "state": "LA",
            "postal_code": "71360",
            "telephone_number": "318-473-9556",
            "fax_number": "318-484-6032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID STATE ORTHOPAEDIC & SPORTS MEDICINE CENTER LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MIDSTATE ORTHOPAEDIC & SPORTS CENTER",
        "enumeration_date": "2016-09-07",
        "last_updated": "2020-07-20",
        "certification_date": "2020-07-20",
        "status": "A",
        "authorized_official_last_name": "DODSON",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "318-473-9556",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "LA",
            "license": "9317843",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1946320",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CD7720",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rachel Robinson Meredith, COTA/L
• Charlotte G. Merrill, APRN, DNP, FNP-C,
• Brittany Jane'T Meshell
• Darnita Metoyer
• Rosa Ashby Metoyer, RN
• John Donald Miller Jr.
• John Winston Miller, MD
• Lakyn Miller, ATC, LAT
• Sabrina Travae Miller, CIT #5363
• Vernon L Mills Sr., LAC/CCS/CCDP-D

• Orthopaedic Surgery Physician in Pineville, LA
• Providers in Pineville, LA by specialty
• Orthopaedic Surgery Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.