Southern Illinois Orthopedic Center,LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

7002421 Issued in IL

Legal business name

SOUTHERN ILLINOIS ORTHOPEDIC CENTER,LLC

Practice address

510 Lincoln Dr
Herrin, IL 62948-6334

Phone

(618) 997-3100

Fax

(618) 997-3616

NPI assigned

Aug 23, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Justin Harris, MSHA, MBA, FACHE

Title

Chief Executive Officer

Phone

(859) 537-7001

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Listed as

Southern Illinois Orthopedic CenterllcCCN 14C0001086

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Southern Illinois Hospital Services

  • Medicare Defined Swing Bed Hospital Unit
  • Murphysboro, IL
  • NPI 1639595036

  Member Of

  NPD member
• Southern Orthopedic Associates, S.C.

  • Orthopaedic Surgery Physician
  • Paducah, KY
  • NPI 1427165554

  Member Of

  NPD member

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716854400000",
    "number": "1023001377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 S CLIFF AVE STE 106",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571045355",
            "telephone_number": "618-997-3100",
            "fax_number": "618-997-3616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 LINCOLN DR",
            "city": "HERRIN",
            "state": "IL",
            "postal_code": "629486334",
            "telephone_number": "618-997-3100",
            "fax_number": "618-997-3616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS ORTHOPEDIC CENTER,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-23",
        "last_updated": "2024-05-28",
        "certification_date": "2024-05-28",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "859-537-7001",
        "authorized_official_credential": "MSHA, MBA, FACHE"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "IL",
            "license": "7002421",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "066440",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "1458",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "441874",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US DEPT OF LABOR",
            "identifier": "133621000",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southern Illinois Hospital Services
• Southern Illinois Hospital Services
• Southern Illinois Hospital Services
• Southern Illinois Medical Services, NFP
• Southern Illinois OB-GYN Associates, S.C.
• Southern Illinois Respiratory Disease Consultants, LLC
• Southern Illinois Rheumatology, SC
• Southern Orthopedic Associates SC
• Southern Rehab Specialists, LLC
• Courtney Sowels, PHARMD

• Ambulatory Surgical Clinic/Center in Herrin, IL
• Providers in Herrin, IL by specialty
• Ambulatory Surgical Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.