# SOUTHLAND BONE & JOINT INSTITUTE, S.C.

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

## Provider details

- **NPI number:** 1194730960
- **Authorized official:** WENDI L JEFFERS (OFFICE MANAGER)
- **Authorized official phone:** (708) 283-2600

## Contact information

- **Practice address:** 20060 GOVERNORS DR, SUITE 300, OLYMPIA FIELDS, IL 60461-1029
- **Practice address phone:** (708) 283-2600
- **Practice address fax:** (708) 283-1250
- **Mailing address:** 20060 GOVERNORS DR, SUITE 300, OLYMPIA FIELDS, IL 60461-1029
- **Mailing address phone:** (708) 283-2600
- **Mailing address fax:** (708) 283-1250

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/30/2006
- **Last updated:** 03/17/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 01632336 | BLUE SHIELD PROVIDER \# | IL |
| 05 | — | 200394600B | — | IN |