NPIMap

Organization Active NPI

Mid State Orthopaedic & Sports Medicine Center LLC

  • Orthopaedic Surgery Physician
  • Jena, LA
National Provider Identifier
1609320506
Registry record updated Apr 26, 2021
On this page

Key facts

NPPES NPI Registry
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
Last updated
Apr 26, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
MID STATE ORTHOPAEDIC & SPORTS MEDICINE CENTER LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 26, 2021

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

Authorized official

Name
Mark A Dodson, M.D.NPI 1487628236
Title
President
Phone
(318) 473-9556

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207X00000X 9317843 LA Primary
Physical Medicine & Rehabilitation PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208100000X 9317843 LA

Addresses

Primary practice location

155 Ninth St
Ste a
Jena, LA 71342-3900

Mailing address

3444 Masonic Dr
Alexandria, LA 71301-3615
Phone (318) 473-9556

National Provider Directory

National Provider Directory
Part of
Mid South Orthopaedic

Locations

224 Pecan Park Ave
Ste C
Alexandria, LA 71303
Phone (318) 427-7851

224 Pecan Park Ave
Ste F
Alexandria, LA 71303
Phone (318) 473-9556

155 Ninth St
Jena, LA 71342
Phone (318) 473-9556

1135 Expressway Dr
Pineville, LA 71360
Phone (318) 442-1026

504 Jack Miller Rd
Ville Platte, LA 70586
Phone (318) 473-9556

601 W Lafayette St
Winnfield, LA 71483
Phone (318) 251-8411

Ownership & related parties

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.

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 22

NPI Registry JSON

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": []
}

Other providers in Jena, LA

Sources for this page

  • 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.