Organization
EFFINGHAM ORTHOPEDIC CLINIC SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BEHROOZ HESHMATPOUR M.D. (PRESIDENT)
(217) 347-5305
Entity
Organization
Contact information
Practice address
802 E JEFFERSON AVE, EFFINGHAM, IL 62401-3409
(217) 347-5305
(217) 347-5305
Mailing address
802 E JEFFERSON AVE, EFFINGHAM, IL 62401-3409
(217) 347-5305
(217) 347-5305
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036064071
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02500061
BLUE CROSS BLUE SHIELD
—
05
—
036064071
—
IL
01
—
078985
HEALTH ALLIANCE
—
01
—
133294100
ACS OWCP
—
01
—
137805
HEALTHLINK
—
01
—
200000910
RAILROAD MEDICARE
—
Enumeration date
06/22/2005
Last updated
07/08/2009
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