NPIMap

Organization Active NPI

Southern Orthopedic Associates, S.C.

  • Orthopaedic Surgery Physician
  • Carrondale, IL
National Provider Identifier
1104075126
Registry record updated Sep 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
042617215 Issued in IL
Legal business name
SOUTHERN ORTHOPEDIC ASSOCIATES, S.C.
Practice address
1101 Diann Lane
Carrondale, IL 62901
Phone
(618) 997-6800
Fax
(618) 457-0211
NPI assigned
Sep 15, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 15, 2008

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

Authorized official

Name
Dr. Thomas West Davis
Title
President/Orthopedic Surgeon
Phone
(618) 997-6800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207X00000X 042617215 IL Primary

Addresses

Primary practice location

1101 Diann Lane
Carrondale, IL 62901

Mailing address

510 Lincoln Drive
Herrin, IL 62948
Phone (618) 997-6800

National Provider Directory

National Provider Directory
Tax ID family
Southern Ortho Assoc PC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1101 W Diann Ln
Carbondale, IL 62901
Phone (618) 997-6800

NPI Registry JSON

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

{
    "created_epoch": "1221436800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221436800000",
    "number": "1104075126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 LINCOLN DRIVE",
            "city": "HERRIN",
            "state": "IL",
            "postal_code": "62948",
            "telephone_number": "618-997-6800",
            "fax_number": "618-457-0211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 DIANN LANE",
            "city": "CARRONDALE",
            "state": "IL",
            "postal_code": "62901",
            "telephone_number": "618-997-6800",
            "fax_number": "618-457-0211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ORTHOPEDIC ASSOCIATES, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-15",
        "last_updated": "2008-09-15",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "WEST",
        "authorized_official_title_or_position": "PRESIDENT/ORTHOPEDIC SURGEON",
        "authorized_official_telephone_number": "618-997-6800",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery",
            "state": "IL",
            "license": "042617215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.