Organization
SOUTHLAND BONE & JOINT INSTITUTE, PSC
Active
Parent organization
SOUTHLAND BONE & JOINT INSTITUTE, S.C.
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOUTHLAND BONE & JOINT INSTITUTE, S.C.
Authorized official
WENDI L JEFFERS (OFFICE MANAGER)
(708) 283-2600
Entity
Organization
Contact information
Practice address
7550 HOHMAN AVE STE 400, MUNSTER, IN 46321-1059
(219) 513-0660
(219) 513-0670
Mailing address
PO BOX 4097, AURORA, IL 60507-4097
(708) 283-2600
(708) 283-1635
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
50004723A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01632336
BLUE SHIELD PROVIDER NUMBER
IL
Enumeration date
10/01/2008
Last updated
02/04/2009
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