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Organization
SOUTHERN ORTHOPEDIC ASSOCIATES SC
Active
Organization
SOUTHERN ORTHOPEDIC ASSOCIATES SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN DAVIS MD (PRESIDENT ORTHOPEDIC SURGEON)
(618) 997-6800
Entity
Organization
Contact information
Practice address
510 LINCOLN DR, HERRIN, IL 62948-6334
(618) 997-6800
Mailing address
510 LINCOLN DRIVE, HERRIN, IL 62948
(618) 997-6800
(618) 998-9124
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
042617215
IL
225100000X
Physical Therapist
—
NULL
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
NULL
225X00000X
Occupational Therapist
—
—
261QP1100X
Podiatric Clinic/Center
—
NULL
332B00000X
Durable Medical Equipment & Medical Supplies
042617215
KY
363A00000X
Physician Assistant
—
KY
Other
Enumeration date
05/27/2006
Last updated
10/04/2022
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