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

155 Ninth St
Ste a
Jena, LA 71342-3900

Phone

(318) 473-9556

Fax

(318) 441-8339

NPI assigned

Aug 9, 2016

Organization subpart

Yes

Parent organization

MID STATE ORTHOPAEDIC & SPORTS MEDICINE CENTER LLCAs reported in NPPES

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

Authorized official

Name

Mark A Dodson, M.D.

Title

President

Phone

(318) 473-9556

Specialties & licenses 2

Addresses

Part of

Mid State Orthopaedic a

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Mid State Orthopaedic & Sports Medicine Center, LLC

  • Orthopaedic Surgery Physician
  • Alexandria, LA
  • NPI 1104890052
  NPPES parent name

Practitioners 32

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark A Carbo, PA-C

  • Physician Assistant
  • Alexandria, LA
  • NPI 1508889312
  NPD
• Larry Justin Doughty, M.D.

  • Pain Medicine Physician
  • Alexandria, LA
  • NPI 1922549211

  Physical Medicine & Rehabilitation

  NPD
• Abby Lou Fennell, O.T.

  • Occupational Therapist
  • Pineville, LA
  • NPI 1740887694
  NPD
• Mandy Guilliams, FNP-C

  • Family Nurse Practitioner
  • Alexandria, LA
  • NPI 1578291258
  NPD
• Tiffany R Hayes, PA-C

  • Physical Therapist
  • Alexandria, LA
  • NPI 1538137906
  NPD
• George H Lacour, OTR, CHT

  • Hand Occupational Therapist
  • Alexandria, LA
  • NPI 1477599645
  NPD
• Janssen Shawn Meeker, DPT

  • Physical Therapist
  • Alexandria, LA
  • NPI 1417409996
  NPD
• Daniel R Oas, D.O.

  • Orthopaedic Surgery Physician
  • Alexandria, LA
  • NPI 1093782443

  Orthopaedic Surgery

  NPD
• Miles Stanley Parsons, M.D.

  • Orthopaedic Surgery Physician
  • Alexandria, LA
  • NPI 1407385586

  Orthopaedic Surgery

  NPD
• Tori Anne Peery, PT, DPT

  • Physical Therapist
  • Pineville, LA
  • NPI 1508611534
  NPD
• Stephen Robert Price, PA-C

  • Physician Assistant
  • Alexandria, LA
  • NPI 1609840438
  NPD
• Rebecca Lynne Smilie, P.T.

  • Physical Therapist
  • Alexandria, LA
  • NPI 1669775805
  NPD

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

{
    "created_epoch": "1470700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619395200000",
    "number": "1609320506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3444 MASONIC DR",
            "city": "ALEXANDRIA",
            "state": "LA",
            "postal_code": "713013615",
            "telephone_number": "318-473-9556",
            "fax_number": "318-441-8339"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 NINTH ST",
            "address_2": "STE A",
            "city": "JENA",
            "state": "LA",
            "postal_code": "713423900",
            "telephone_number": "318-473-9556",
            "fax_number": "318-441-8339"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID STATE ORTHOPAEDIC & SPORTS MEDICINE CENTER LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MID STATE ORTHOPAEDIC & SPORTS MEDICINE CENTER LLC",
        "enumeration_date": "2016-08-09",
        "last_updated": "2021-04-26",
        "certification_date": "2021-04-26",
        "status": "A",
        "authorized_official_last_name": "DODSON",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "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
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "LA",
            "license": "9317843",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Reba Miller, LPN
• Sarah Molan
• Glenda Pritchard Parker
• Cheston Paul, PHARMACIST
• Destinee Paul

• All providers in Jena, LA
• Orthopaedic Surgery Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2021; 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.