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Organization
DECATUR ORTHOPEDIC CENTER, LLC
Active
Organization
DECATUR ORTHOPEDIC CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACOB D SAMS MD (CHIEF MANAGING MEMBER)
(217) 864-2665
Entity
Organization
Contact information
Practice address
104 ASHLAND AVE., MT. ZION, IL 62549
(217) 864-2665
Mailing address
104 ASHLAND AVE., MT. ZION, IL 62549
(217) 864-2665
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
125-052745
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1154511517
INDIVIDUAL NPI
IL
01
—
1730340498
INDIVIDUAL NPI
IL
Enumeration date
06/03/2013
Last updated
02/23/2022
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