| NPI | 1104890052 |
|---|---|
| Former Legal Business Name | MID-STATE ORTHOPAEDIC & SPORTS MEDICINE CENTER INC |
| Entity Type | Organization |
| Authorized Contact | NAKITA C WILLIAMS Credentialing Manager 318-441-8329 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 213E00000X Podiatrist |
| 225100000X Physical Therapist | |
| 225X00000X Occupational Therapist | |
| Enumeration Date | 2006-02-16 |
| Last Update Date | 2024-01-02 |