Provider Demographics
NPI:1073221545
Name:ORTHO SPORT & SPINE PHYSICIANS OF MISSISSIPPI, LLC
Entity Type:Organization
Organization Name:ORTHO SPORT & SPINE PHYSICIANS OF MISSISSIPPI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGEMENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:
Authorized Official - Last Name:BELTZHOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-752-7246
Mailing Address - Street 1:5788 ROSWELL RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-4904
Mailing Address - Country:US
Mailing Address - Phone:678-752-7246
Mailing Address - Fax:
Practice Address - Street 1:4316 OLD CANTON RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211-5995
Practice Address - Country:US
Practice Address - Phone:601-202-3965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty