Basic Information
| Provider Information | |||||||||
| NPI: | 1114175585 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MID-SOUTH ORTHOPEDIC HOSPITALISTS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 952192 | ||||||||
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| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 753950001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304703700 | ||||||||
| FaxNumber: | 3304977940 | ||||||||
| Practice Location | |||||||||
| Address1: | 7535 AIRWAYS BLVD | ||||||||
| Address2: | |||||||||
| City: | SOUTHAVEN | ||||||||
| State: | MS | ||||||||
| PostalCode: | 386715834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6623490248 | ||||||||
| FaxNumber: | 6623499023 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2008 | ||||||||
| LastUpdateDate: | 04/15/2011 | ||||||||
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| AuthorizedOfficialLastName: | JOYCE | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8668855522 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MS | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.