Provider Demographics
NPI:1982052692
Name:PREMIER HOPE ORTHOTIC & PROSTHETIC ENTERPRISES OF MISSISSIPPI, LLC
Entity Type:Organization
Organization Name:PREMIER HOPE ORTHOTIC & PROSTHETIC ENTERPRISES OF MISSISSIPPI, LLC
Other - Org Name:HOPE OF MISSISSIPPI
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS OWNER/CLINICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:LINDSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CP, BOCO
Authorized Official - Phone:318-235-8677
Mailing Address - Street 1:152 WATFORD PARK WAY DR
Mailing Address - Street 2:SUITE 147
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-7900
Mailing Address - Country:US
Mailing Address - Phone:318-235-8677
Mailing Address - Fax:
Practice Address - Street 1:152 WATFORD PARK WAY DR
Practice Address - Street 2:SUITE 147
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-7900
Practice Address - Country:US
Practice Address - Phone:318-235-8677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-03
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier