Healthcare Provider Details

I. General information

NPI: 1306067277
Provider Name (Legal Business Name): PEDIATRIC ORTHOPAEDIC SPECIALISTS OF MISSISSIPPI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 N STATE ST SUITE 204
JACKSON MS
39202-2413
US

IV. Provider business mailing address

1190 N STATE ST SUITE 204
JACKSON MS
39202-2413
US

V. Phone/Fax

Practice location:
  • Phone: 601-353-8066
  • Fax: 601-353-8155
Mailing address:
  • Phone: 601-353-8066
  • Fax: 601-353-8155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number
License Number StateMS

VIII. Authorized Official

Name: MISS LESLIE ELIZABETH HOBBS
Title or Position: OFFICE MANAGER
Credential:
Phone: 601-353-8066