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SOUTHERN ORTHOPEDIC ASSOCIATES S.C. NPI 1104075126


NPI Information

NPI: 1104075126
Provider Name: SOUTHERN ORTHOPEDIC ASSOCIATES, S.C.
Classification: Orthopaedic Surgery - 207X00000X
Entity Type: Organization

CLIA Number: 14D0436414

Address:
1101 DIANN LANE
CARRONDALE, IL
ZIP 62901
Phone: (618) 997-6800
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SOUTHERN ORTHOPEDIC ASSOCIATES, S.C. is an orthopaedic surgery in Carrondale, IL. The provider is 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. SOUTHERN ORTHOPEDIC ASSOCIATES, S.C. NPI is 1104075126. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1101 DIANN LANE
CARRONDALE, IL
ZIP 62901
Phone: (618) 997-6800
Fax: (618) 457-0211

The provider's authorized official is Thomas West Davis .
The authorized official title is President/orthopedic Surgeon and has the following contact phone number (618) 997-6800.

The CLIA number assigned to this NPI record is 14D0436414 - federally qualified health center with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 9/15/2008 and was last updated on 9/15/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207X00000XOrthopaedic Surgery042617215ILLINOISYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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