Mid State Orthopaedic & Sports Medicine Center, LLC
Organization Active NPI Orthopaedic Surgery Physician · Alexandria, LA
NPI 1104890052 · NPPES record last updated Mar 24, 2026
Key facts
- NPI
- 1104890052
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Orthopaedic Surgery Physician 207X00000X
- Legal business name
- MID STATE ORTHOPAEDIC & SPORTS MEDICINE CENTER, LLC
- Practice address
- 3444 Masonic Drive
Alexandria, LA 71301 - Phone
- (318) 473-9556
- Fax
- (318) 441-8339
- NPI assigned
- Feb 16, 2006
- Organization subpart
- No
Authorized official
- Name
- Nakita C Hickman
- Title
- Credentialing Manager
- Phone
- (318) 441-8329
Subparts reporting this organization as parent 2
Practitioners 48
-
Larry Justin Doughty, M.D.
-
Abby Lou Fennell, O.T.
-
Mandy Guilliams, FNP-C
-
George H Lacour, OTR, CHT
-
Janssen Shawn Meeker, DPT
-
Daniel R Oas, D.O.
-
Miles Stanley Parsons, M.D.
-
Tori Anne Peery, PT, DPT
-
Rebecca Lynne Smilie, P.T.
-
Amy Laura Stallings, P.T.
-
Klaire Elizabeth Sutton, O.T.
-
Mark A Carbo, PA-C
-
William David Crenshaw, M.D.
-
Jeffrey L Garrison, M.D.
-
Jeanne Harrison, FNP-C
-
Tiffany R Hayes, PA-C
-
Stephen Robert Price, PA-C
-
Timmothy R Randell, M.D.
-
Jamie L Rister, M.D.
-
William David Rogenmoser, D.O.
-
James A Thomas, FNP-C
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Mid-State Orthopaedic and Sports Me |
Canes and/or Crutches|Walkers|Wheelchairs (Standard Manual Related Accessories)|Wheelchairs (Standard Power)|Wheelchair Seating/Cushions|Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Diabetic Shoes and Inserts|Diabetic Shoes/Inserts - Custom | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in LA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041208000292 | LA | Part B Supplier - Clinic/Group Practice | 6204892540 |
Receives reassigned benefits from 27 practitioners Practice locations: Alexandria, LA; Jena, LA; Leesville, LA; Natchitoches, LA; Pineville, LA; Ville Platte, LA |
| O20100930036471 | LA | DME Supplier - Physician - Orthopedic/Orthopedic Surgery |
6204892540 | Practice locations: Alexandria, LA |
National Provider Directory
Locations
224 Pecan Park Ave
Alexandria, LA 71303
Phone (318) 427-7900
224 Pecan Park Ave
Ste F
Alexandria, LA 71303
Phone (318) 473-9556
224 Pecan Park Ave
Ste B
Alexandria, LA 71303
Phone (318) 427-7851
1587 N Bolton Ave
Ste 1100
Alexandria, LA 71303
Phone (318) 445-9823
155 Ninth St
#A
Jena, LA 71342
155 Ninth St
Ste A
Jena, LA 71342
Phone (318) 473-9556
1135 Expressway Dr
Ste 100A
Pineville, LA 71360
429 Rocky Bayou Dr
Ste B
Pineville, LA 71360
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician |
207X00000X | Yes | ||
| Physical Medicine & Rehabilitation Physician |
208100000X | |||
| Physical Therapist |
225100000X | |||
| Occupational Therapist |
225X00000X |
Addresses
Primary practice location
3444 Masonic Drive
Alexandria, LA 71301
Mailing address
3444 Masonic Drive
Alexandria, LA 71301
Phone (318) 473-9556
Other practice location 1
429 Rocky Bayou Dr
Pineville, LA 71360-8133
Phone (318) 441-8329
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0570570001 | Other | LA | MEDICARE DME GROUP # |
| CD7720 | Other | LA | RAILROAD MEDICARE PALMETT |
| 1946320 | Medicaid | LA |
Other names
- Mid-State Orthopaedic & Sports Medicine Center Inc
Other providers in Alexandria, LA
- Matthew J Meynard
- Michael Dole MD, a Professional Medical Corp.
- Jeremy James Michot
- Megan Mickel
- Mid Louisiana Surgical Specialists
- Mid State Orthopaedic Urgent Care, LLC
- Mid State Orthopaedics & Sports Medicine Center LLC
- Mid State Surgical Center, LLC
- Mid- State Home Health Agency Inc
- Mid-Louisiana Anesthesia Consultants, Apmc
All providers in Alexandria, LA · Orthopaedic Surgery Physician in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 24, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.