1730202078 NPI number — STARKVILLE ORTHOPEDIC CLINIC, LLC

Table of content: MS. CAROL ANN MARIE PISAPIA PT (NPI 1548465701)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730202078 NPI number — STARKVILLE ORTHOPEDIC CLINIC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STARKVILLE ORTHOPEDIC CLINIC, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730202078
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 WILBURN WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STARKVILLE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-320-4008
Provider Business Mailing Address Fax Number:
662-320-2450

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 WILBURN WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STARKVILLE
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39759-3692
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-320-4008
Provider Business Practice Location Address Fax Number:
662-320-2450
Provider Enumeration Date:
04/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
TODD
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
662-320-4008

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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