| NPI | 1124587829 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT LANCE JOHANSEN CEO 228-328-2400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery |
| Enumeration Date | 2019-03-13 |
| Last Update Date | 2019-03-13 |