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General NPI Number Information
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NPI Number | 1437299344
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Entity Type | Organization
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Legal Business Name | MISSISSIPPI ORTHOPAEDICS & SPORTS MEDICINE, PLLC
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 07/03/2013
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Provider Practice Location Address
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Address Line | 391 SOUTHCREST CIR SUITE 205
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City | SOUTHAVEN
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State | MS
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Zip | 38671-6730
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Country | US
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Telephone | 662-536-0900
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1107
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City | SOUTHAVEN
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State | MS
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Zip | 38671-0111
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Country | US
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Telephone | 662-536-0900
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Fax | 662-536-0914
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | RITA B CHRISTIAN
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Credential | R.N.
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Telephone | 662-536-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 11962
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License Number State | MS
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