Provider Demographics
NPI:1568410058
Name:ADVANCED ORTHOPEDICS, PLLC
Entity Type:Organization
Organization Name:ADVANCED ORTHOPEDICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:ARLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-533-4333
Mailing Address - Street 1:PO BOX 7144
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39506-7144
Mailing Address - Country:US
Mailing Address - Phone:228-822-2663
Mailing Address - Fax:228-604-2255
Practice Address - Street 1:1639 E PASS RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507
Practice Address - Country:US
Practice Address - Phone:228-822-2663
Practice Address - Fax:228-604-2255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00127085Medicaid
DA3947OtherMEDICARE RAILROAD
MS00127085Medicaid
DA3947OtherMEDICARE RAILROAD