CHAMPION ORTHOPAEDICS DESOTO, PLLC (NPI# 1619346111) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619346111 |
| Entity Type | Organization |
| Organization Name | CHAMPION ORTHOPAEDICS DESOTO, PLLC |
| Other Organization Name | CHAMPION ORTHOPAEDICS |
| Practice Address |
6518 Goodman Rd Ste 104 Olive Branch MS 38654-9809 |
| Mailing Address |
Po Box 1607 Olive Branch MS 38654-0955 |
| Practice Telephone | 6624207350 |
| Practice Fax Number | 6628745214 |
| Mailing Telephone | 6624207350 |
| Mailing Fax Number | 6628745214 |
| Enumeration Date | 2015-09-15 |
| Last Update Date | 2020-03-18 |
| Authorized Official Name | JENNIFER C BULLOCK (PRESIDENT) |
| Authorized Official Telephone | 6625342227 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207X00000X | Orthopaedic Surgery | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 02654844 | 05 | |
| MS | MEDICARE PTAN | 512G700048 | 01 |
| MS | MEDICARE DME PTAN | 6131110004 | 01 |
| Other Name | Type Code |
|---|---|
| Champion Orthopaedics | Doing Business As Name - Organization |
| Street Address |
6518 GOODMAN RD STE 104 |
| City | OLIVE BRANCH |
| State | MS |
| Zip Code | 38654-9809 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992109094 | Mitias Orthopaedics, Pllc | Durable Medical Equipment & Medical Supplies | 6518 Goodman Rd Ste 104, Olive Branch, MS 38654-9809 | 2014-10-17 |
| 1265062541 | Timothy W. Pickens | Nurse Practitioner | 6518 Goodman Rd Ste 104, Olive Branch, MS 38654-9809 | 2020-01-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093366213 | Latonya Shontae Binion | Home Health | 5915 Brice Cove North, Olive Branch, MS 38654 | 2019-09-28 |
| 1356828677 | Heath Bryan Coleman, Dds of Mississippi II, Pllc | Dentist | 688 Goodman Rd, Ste 123, Olive Branch, MS 38654 | 2018-07-20 |
| 1629565684 | Alexis Summerville Mcdavis | Pharmacist | 7950 Craft Goodman Frontage Rd, Olive Branch, MS 38654 | 2018-04-16 |
| 1194237206 | Exos Physical Therapy and Sports Medicine, LLC | Physical Therapist | 6542 Goodman Rd, Olive Branch, MS 38654 | 2017-10-30 |
| 1609386515 | Laken Hood Richardson | Physical Therapist | 9085 East Sandidge Cove, Suite 250, Olive Branch, MS 38654 | 2017-10-05 |
| 1275064255 | Heart of Hospice, LLC | Hospice Care, Community Based | 9849 Highway 178 Unit B, Olive Branch, MS 38654 | 2017-03-22 |
| 1023557865 | Michael Patrick Mccallum | Counselor | 9320 Railroad Ave., Olive Branch, MS 38654 | 2017-02-13 |
| 1891179768 | Desoto Children's Clinic - Olive Branch | Pediatrics | 7145 Goodman Road, Olive Branch, MS 38654 | 2015-07-10 |
| 1891185203 | Kristina Harper | Midwife | 9086 Pigeon Roost Rd Ste C, Olive Branch, MS 38654 | 2015-01-23 |
| 1275955098 | Global Medical | Durable Medical Equipment & Medical Supplies | 6229 Hwy 305 Ste L, Olivebranch, MS 38654 | 2014-01-14 |
| Find all providers in zip 38654 | ||||
| Taxonomy Code | 207X00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. American Osteopathic Board of Orthopaedic Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Orthopaedic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124015821 | Robert M Pickering | Orthopaedic Surgery | 9085 Sandidge Center Cv, Olive Branch, MS 38654-3575 | 2005-09-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619526852 | Msk Group, PC | Orthopaedic Surgery | 7900 Airways Blvd Bldg B102, Southaven, MS 38671-4118 | 2019-09-10 |
| 1790193050 | Och Orthopedic Center | Orthopaedic Surgery | 401 Hospital Rd, Starkville, MS 39759-2164 | 2014-07-30 |
| 1679909774 | Irvin L. Martin IIi Md Pllc | Orthopaedic Surgery | 1800 12th St Ste 1e, Meridian, MS 39301-4158 | 2013-09-20 |
| 1073946216 | Madison Physician Surgery Center, LLC | Orthopaedic Surgery | 4510 Lakeland Dr, Flowood, MS 39232-9583 | 2013-08-12 |
| 1386076743 | William Ladwick Hand | Orthopaedic Surgery | 304 Kings Common, Ridgeland, MS 39157 | 2013-08-07 |
| 1184068413 | Thomas Payne Royals | Orthopaedic Surgery | 103 Tatum Rd, Hattiesburg, MS 39401-5186 | 2013-04-17 |
| 1639426117 | Southern Bone & Joint Specialists, Pa | Orthopaedic Surgery | 7127 Highway 98, Suite 20, Hattiesburg, MS 39402 | 2012-08-14 |
| 1487901807 | Southern Bone & Joint Specialists, Pa | Orthopaedic Surgery | 1215 Highway 98 Byp, Columbia, MS 39429-3702 | 2012-08-06 |
| 1477817799 | Matthew A Miller | Orthopaedic Surgery | 1211 South Gloster St, Suite A, Tupelo, MS 38801 | 2012-07-02 |
| 1831453158 | Phillip Anthony Sandifer | Orthopaedic Surgery | 100 Baptist Memorial Cir Ste 330, Oxford, MS 38655-4477 | 2012-07-02 |
| Find all providers with the same taxonomy | ||||
| City | OLIVE BRANCH |
| Zip Code | 38654 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.