# ORTHOPEDIC & SPORTS MEDICINE CENTER

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

## Provider details

- **NPI number:** 1972611044
- **Authorized official:** STEPHEN STOUT (CHIEF OPERATING OFFICER)
- **Authorized official phone:** (309) 454-1616

## Contact information

- **Practice address:** 2200 FORT JESSE RD STE 250, NORMAL, IL 61761-6290
- **Practice address phone:** (309) 454-1616
- **Mailing address:** PO BOX 1645, BLOOMINGTON, IL 61702-1645

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | 042-616684 | IL | Yes |

## Other

- **Enumeration date:** 08/28/2006
- **Last updated:** 03/23/2011