# SOUTHERN ORTHOPEDIC ASSOCIATES SC

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

## Provider details

- **NPI number:** 1396792412
- **Authorized official:** DR. JOHN DAVIS MD (PRESIDENT ORTHOPEDIC SURGEON)
- **Authorized official phone:** (618) 997-6800

## Contact information

- **Practice address:** 510 LINCOLN DR, HERRIN, IL 62948-6334
- **Practice address phone:** (618) 997-6800
- **Mailing address:** 510 LINCOLN DRIVE, HERRIN, IL 62948
- **Mailing address phone:** (618) 997-6800
- **Mailing address fax:** (618) 998-9124

## Taxonomy

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