Healthcare Provider Details

I. General information

NPI: 1003740358
Provider Name (Legal Business Name): BIENVILLE ORTHOPAEDIC SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 REDD LN
LUCEDALE MS
39452-5292
US

IV. Provider business mailing address

6300 E LAKE BLVD STE 301
VANCLEAVE MS
39565-6771
US

V. Phone/Fax

Practice location:
  • Phone: 228-230-2663
  • Fax:
Mailing address:
  • Phone: 228-230-2663
  • Fax: 228-206-6398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: LEE BOND
Title or Position: CEO
Credential:
Phone: 228-230-2663