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Organization
ORTHOPAEDIC CENTER OF SOUTHERN ILLINOIS, LTD.
Active
Organization
ORTHOPAEDIC CENTER OF SOUTHERN ILLINOIS, LTD.
Active
Parent organization
ORTHOPAEDIC CENTER OF SOUTHERN ILLINOIS, LTD.
Organization subpart
Yes
Provider details
NPI number
Legal business name
ORTHOPAEDIC CENTER OF SOUTHERN ILLINOIS, LTD.
Authorized official
DR. JEAN BENOIT HOULE MD (PRESIDENT)
(618) 242-3778
Entity
Organization
Contact information
Practice address
839 M L KING DRIVE, CENTRALIA, IL 62801-3001
(618) 545-0894
(618) 545-0914
Mailing address
4121 VETERANS MEMORIAL DR, MOUNT VERNON, IL 62864-6262
(618) 242-3778
(618) 242-2551
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
NULL
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CN2166
RR MEDICARE PIN
—
Enumeration date
09/08/2009
Last updated
10/11/2022
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