Provider Demographics
NPI:1578029070
Name:BIENVILLE ORTHOPAEDIC SPECIALISTS, LLC
Entity Type:Organization
Organization Name:BIENVILLE ORTHOPAEDIC SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-230-2663
Mailing Address - Street 1:6300 EAST LAKE BLVD.
Mailing Address - Street 2:SUITE 301
Mailing Address - City:VANCLEAVE
Mailing Address - State:MS
Mailing Address - Zip Code:39565-6771
Mailing Address - Country:US
Mailing Address - Phone:288-230-2663
Mailing Address - Fax:228-206-1192
Practice Address - Street 1:6300 EAST LAKE BLVD.
Practice Address - Street 2:SUITE 201
Practice Address - City:VANCLEAVE
Practice Address - State:MS
Practice Address - Zip Code:39565-6771
Practice Address - Country:US
Practice Address - Phone:228-230-2663
Practice Address - Fax:228-206-1192
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BIENVILLE ORTHOPAEDIC SPECIALISTS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-02-20
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty