# ORTHOPAEDIC CENTER OF ILLINOIS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013313832
- **Authorized official:** MELISSA SMITH (EXECUTIVE ADMINISTRATIVE ASSISTANT)
- **Authorized official phone:** (217) 547-9100

## Contact information

- **Practice address:** 1301 S KOKE MILL RD, SPRINGFIELD, IL 62711-9252
- **Practice address phone:** (217) 547-9100
- **Practice address fax:** (217) 547-9236
- **Mailing address:** 1301 S KOKE MILL RD, SPRINGFIELD, IL 62711-9252
- **Mailing address phone:** (217) 547-9100
- **Mailing address fax:** (217) 547-9236

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | 042007969 | IL | — |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | 042007969 | IL | Yes |

## Other

- **Enumeration date:** 11/05/2014
- **Last updated:** 11/06/2020