Provider Demographics
NPI:1902969751
Name:THE OFFICE OF BONE AND JOINT SURGERY, P.C.
Entity Type:Organization
Organization Name:THE OFFICE OF BONE AND JOINT SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:662-536-2526
Mailing Address - Street 1:7900 AIRWAYS BLVD BLDG A1
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-4116
Mailing Address - Country:US
Mailing Address - Phone:662-536-2526
Mailing Address - Fax:662-536-1307
Practice Address - Street 1:7900 AIRWAYS BLVD BLDG A1
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-4116
Practice Address - Country:US
Practice Address - Phone:662-536-2526
Practice Address - Fax:662-536-1307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0009Medicaid
MS09105501Medicaid
MS0666250001Medicare NSC
TN0009Medicare PIN
MSDA1198Medicare PIN
MSC02822Medicare PIN