# SOUTHERN ORTHOPEDIC ASSOCIATES, S.C.

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

## Provider details

- **NPI number:** 1104075126
- **Authorized official:** DR. THOMAS WEST DAVIS (PRESIDENT/ORTHOPEDIC SURGEON)
- **Authorized official phone:** (618) 997-6800

## Contact information

- **Practice address:** 1101 DIANN LANE, CARRONDALE, IL 62901
- **Practice address phone:** (618) 997-6800
- **Practice address fax:** (618) 457-0211
- **Mailing address:** 510 LINCOLN DRIVE, HERRIN, IL 62948
- **Mailing address phone:** (618) 997-6800
- **Mailing address fax:** (618) 457-0211

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | 042617215 | IL | Yes |

## Other

- **Enumeration date:** 09/15/2008
- **Last updated:** 09/15/2008