Organization
SOUTHERN ILLINOIS ORTHOPEDIC CENTER,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JUSTIN HARRIS MSHA, MBA, FACHE (CHIEF EXECUTIVE OFFICER)
(859) 537-7001
Entity
Organization
Contact information
Practice address
510 LINCOLN DR, HERRIN, IL 62948-6334
(618) 997-3100
(618) 997-3616
Mailing address
600 S CLIFF AVE STE 106, SIOUX FALLS, SD 57104-5355
(618) 997-3100
(618) 997-3616
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
7002421
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
066440
HEALTH ALLIANCE
—
01
—
133621000
US DEPT OF LABOR
—
01
—
1458
BC/BS
IL
01
—
441874
HEALTHLINK
—
Enumeration date
08/23/2005
Last updated
05/28/2024
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