Provider Demographics
NPI:1316366503
Name:BIENVILLE ORTHOPAEDIC SPECIALISTS LLC
Entity Type:Organization
Organization Name:BIENVILLE ORTHOPAEDIC SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANNAGER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:ROLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-546-3254
Mailing Address - Street 1:1720A MEDICAL PARK DR STE 220
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-2127
Mailing Address - Country:US
Mailing Address - Phone:228-546-3254
Mailing Address - Fax:228-396-2507
Practice Address - Street 1:1720A MEDICAL PARK DR STE 220
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2127
Practice Address - Country:US
Practice Address - Phone:228-546-3254
Practice Address - Fax:228-396-2507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19613332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site