MEDICARE: BIENVILLE ORTHOPAEDIC SPECIALISTS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1689605834
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIENVILLE ORTHOPAEDIC SPECIALISTS, LLC

Provider Business Mailing Address
First Line	:	6300 EAST LAKE BLVD.
Second Line	:	SUITE 301
City	:	VANCLEAVE
State	:	MS
Zip	:	39565-6771
Country	:	US
Telephone Number	:	228-230-2663
Fax Number	:	228-206-6398

Provider Business Practice Location Address
First Line	:	6300 EAST LAKE BLVD.
Second Line	:	SUITE 201
City	:	VANCLEAVE
State	:	MS
Zip	:	39565-6771
Country	:	US
Telephone Number	:	228-230-2663
Fax Number	:	228-206-1192

Authorized Official
Title or Position	:	CEO
Name	:	LEE BOND
Credential	:
Telephone Number	:	228-230-2663

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	09/16/2024

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