Provider Demographics
NPI:1710075486
Name:NORTH EAST ORTHOPAEDICS PA
Entity Type:Organization
Organization Name:NORTH EAST ORTHOPAEDICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PILLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-377-6700
Mailing Address - Street 1:4381 S EASON BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6583
Mailing Address - Country:US
Mailing Address - Phone:662-377-6700
Mailing Address - Fax:662-377-6706
Practice Address - Street 1:4381 S EASON BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6586
Practice Address - Country:US
Practice Address - Phone:662-377-6700
Practice Address - Fax:662-377-6706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS13958207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02629297Medicaid
MS5273030001Medicare NSC
MS02629297Medicaid