# SOUTHERN ILLINOIS ORTHOPEDIC CENTER,LLC

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

## Provider details

- **NPI number:** 1023001377
- **Authorized official:** JUSTIN HARRIS MSHA, MBA, FACHE (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (859) 537-7001

## Contact information

- **Practice address:** 510 LINCOLN DR, HERRIN, IL 62948-6334
- **Practice address phone:** (618) 997-3100
- **Practice address fax:** (618) 997-3616
- **Mailing address:** 600 S CLIFF AVE STE 106, SIOUX FALLS, SD 57104-5355
- **Mailing address phone:** (618) 997-3100
- **Mailing address fax:** (618) 997-3616

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 7002421 | IL | Yes |

## Other

- **Enumeration date:** 08/23/2005
- **Last updated:** 05/28/2024