Mo Services LLC

Primary specialty

Adult Reconstructive Orthopaedic Surgery PhysicianTaxonomy code 207XS0114X

Legal business name

MO SERVICES LLC

Practice address

15190 Community Rd.
Suite 120
Gulfport, MS 39503-3484

Phone

(228) 328-2400

Fax

(228) 328-4200

NPI assigned

Mar 13, 2019

Organization subpart

No

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

Authorized official

Name

Robert Lance Johansen, M.D.

Title

Ceo

Phone

(228) 328-2400

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1552435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552435200000",
    "number": "1124587829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15190 COMMUNITY RD.",
            "address_2": "SUITE 120",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395033484",
            "telephone_number": "228-328-2400",
            "fax_number": "228-328-4200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15190 COMMUNITY RD.",
            "address_2": "SUITE 120",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395033484",
            "telephone_number": "228-328-2400",
            "fax_number": "228-328-4200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MO SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-13",
        "last_updated": "2019-03-13",
        "status": "A",
        "authorized_official_last_name": "JOHANSEN",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "LANCE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "228-328-2400",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207XS0114X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04232510",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dana Alexis Mixon, PCMHT
• James Adam Mixon, PHARMD
• John Miyakawa, PHYSICIAN ASSISTANT
• Amanda Renia Mizell, CRNP
• MKB Pharmacy, Inc
• Donna Moberg, LPN
• Surbhibahen Sanjaykumar Modi
• Khaled Mohamed, MD
• Majaazuddin Mohammed, M.D.
• Safia Mohiuddin, MD

• Adult Reconstructive Orthopaedic Surgery Physician in Gulfport, MS
• Providers in Gulfport, MS by specialty
• Adult Reconstructive Orthopaedic Surgery Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2019; 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.