# ORTHOPAEDIC CENTER OF SOUTHERN ILLINOIS, LTD.

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ORTHOPAEDIC CENTER OF SOUTHERN ILLINOIS, LTD.
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1932432143
- **Legal business name:** ORTHOPAEDIC CENTER OF SOUTHERN ILLINOIS, LTD.
- **Authorized official:** DR. JEAN BENOIT HOULE MD (PRESIDENT)
- **Authorized official phone:** (618) 242-3778

## Contact information

- **Practice address:** 839 M L KING DRIVE, CENTRALIA, IL 62801-3001
- **Practice address phone:** (618) 545-0894
- **Practice address fax:** (618) 545-0914
- **Mailing address:** 4121 VETERANS MEMORIAL DR, MOUNT VERNON, IL 62864-6262
- **Mailing address phone:** (618) 242-3778
- **Mailing address fax:** (618) 242-2551

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/08/2009
- **Last updated:** 10/11/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | CN2166 | RR MEDICARE PIN | — |