# LINCOLN TRAIL ORTHOPAEDIC CLINIC, S.C.

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

## Provider details

- **NPI number:** 1366615668
- **Authorized official:** MRS. JULEE LEE (OFFICE MANAGER)
- **Authorized official phone:** (217) 348-1052

## Contact information

- **Practice address:** 103 PROFESSIONAL PLZ, MATTOON, IL 61938-9252
- **Practice address phone:** (217) 348-1030
- **Practice address fax:** (217) 348-1090
- **Mailing address:** 103 PROFESSIONAL PLZ, MATTOON, IL 61938-9252
- **Mailing address phone:** (217) 348-1030
- **Mailing address fax:** (217) 348-1090

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | 036058473 | IL | Yes |

## Other

- **Enumeration date:** 04/08/2008
- **Last updated:** 04/08/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 002811 | HEALTH ALLIANCE | IL |
| 05 | — | 036058473 | — | IL |
| 01 | — | 133038 | HEALTHLINK | IL |
| 01 | — | 1515701 | BLUE CROSS BLUE SHIELD | IL |
| 01 | — | 791203439 | RAILROAD MEDICARE | IL |