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General NPI Number Information
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NPI Number | 1316366503
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Entity Type | Organization
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Legal Business Name | BIENVILLE ORTHOPAEDIC SPECIALISTS LLC
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 04/15/2014
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Provider Practice Location Address
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Address Line | 1720A MEDICAL PARK DR STE 220
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City | BILOXI
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State | MS
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Zip | 39532-2127
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Country | US
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Telephone | 228-546-3254
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Fax | 228-396-2507
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Provider Business Mailing Address
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Address Line | 1720A MEDICAL PARK DR STE 220
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City | BILOXI
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State | MS
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Zip | 39532-2127
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Country | US
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Telephone | 228-546-3254
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Fax | 228-396-2507
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Authorized Official
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Title or Position | MANNAGER
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Name | JEFF WAYNE ROLLINS
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Credential |
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Telephone | 228-546-3254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | 19613
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License Number State | MS
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