Organization
BONUTTI ORTHOPEDIC SERVICES LTD
Active
Parent organization
PRACTICE ACQUISITION INC
Other names
Sarah Bush Lincoln Bonutti Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
PRACTICE ACQUISITION INC
Authorized official
DENNIS PLUARD (CFO & VP OF OPERATIONS)
(217) 258-2102
Entity
Organization
Contact information
Practice address
1303 W EVERGREEN AVE, SUITE 101, EFFINGHAM, IL 62401
(217) 342-3400
(217) 342-6416
Mailing address
1303 W EVERGREEN AVE STE 101, EFFINGHAM, IL 62401-1619
(217) 342-3400
(217) 342-6416
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
060005120
IL
207XS0106X
Orthopaedic Hand Surgery Physician
060005120
IL
207XS0117X
Orthopaedic Surgery of the Spine Physician
—
IL
2083S0010X
Sports Medicine (Preventive Medicine) Physician
060005120
IL
2083X0100X
Occupational Medicine Physician
060005120
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
166708
HEALTHLINK
IL
01
—
2500074
BLUECROSS BLUE SHIELD
IL
Enumeration date
05/17/2006
Last updated
05/22/2018
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