NPIMap

Bienville Orthopaedic Specialists, LLC

Organization Active NPI Occupational Therapist · Vancleave, MS

NPI 1578029070 · NPPES record last updated Sep 7, 2023

Key facts

NPI
1578029070
Entity type
Organization (NPI type 2)
Primary specialty
Occupational Therapist 225X00000X
Legal business name
BIENVILLE ORTHOPAEDIC SPECIALISTS, LLC
Practice address
6300 East Lake Blvd.
Suite 201
Vancleave, MS 39565-6771
Phone
(228) 230-2663
Fax
(228) 206-1192
NPI assigned
Feb 20, 2019
Organization subpart
Yes
Parent organization (as reported)
BIENVILLE ORTHOPAEDIC SPECIALISTS, LLC

Authorized official

Name
Lee Bond
Title
Ceo
Phone
(228) 230-2663

Corporate family (same tax ID) 5

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
Bienville Orthopaedic S (6 organizations share this tax ID)
Part of
Bienville Orthopaedic S

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist
Group: 193200000X MULTI-SPECIALTY GROUP		 225100000X
Occupational Therapist
Group: 193200000X MULTI-SPECIALTY GROUP		 225X00000X Yes

Addresses

Primary practice location

6300 East Lake Blvd.
Suite 201
Vancleave, MS 39565-6771

Mailing address

6300 East Lake Blvd.
Suite 301
Vancleave, MS 39565-6771
Phone (288) 230-2663

Other practice location 1

15476 Dedeaux Rd
Gulfport, MS 39503-2637
Phone (228) 230-2663

Other practice location 2

1720A Medical Park Dr Ste 210
Biloxi, MS 39532-2122
Phone (228) 230-2663

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 7, 2023.

{
    "created_epoch": "1550620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694044800000",
    "number": "1578029070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6300 EAST LAKE BLVD.",
            "address_2": "SUITE 301",
            "city": "VANCLEAVE",
            "state": "MS",
            "postal_code": "395656771",
            "telephone_number": "288-230-2663",
            "fax_number": "228-206-1192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6300 EAST LAKE BLVD.",
            "address_2": "SUITE 201",
            "city": "VANCLEAVE",
            "state": "MS",
            "postal_code": "395656771",
            "telephone_number": "228-230-2663",
            "fax_number": "228-206-1192"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "15476 Dedeaux Rd",
            "address_purpose": "LOCATION",
            "city": "Gulfport",
            "state": "MS",
            "postal_code": "395032637",
            "country_code": "US",
            "telephone_number": "228-230-2663",
            "fax_number": "228-547-3257",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1720A Medical Park Dr Ste 210",
            "address_purpose": "LOCATION",
            "city": "Biloxi",
            "state": "MS",
            "postal_code": "395322122",
            "country_code": "US",
            "telephone_number": "228-230-2663",
            "fax_number": "228-546-3257",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BIENVILLE ORTHOPAEDIC SPECIALISTS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BIENVILLE ORTHOPAEDIC SPECIALISTS, LLC",
        "enumeration_date": "2019-02-20",
        "last_updated": "2023-09-07",
        "certification_date": "2023-09-07",
        "status": "A",
        "authorized_official_last_name": "BOND",
        "authorized_official_first_name": "LEE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "228-230-2663"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancleave, MS

All providers in Vancleave, MS · Occupational Therapist in Mississippi

Sources for this page

Verify at the official NPI Registry.