MEDICARE: SOUTHERN ILLINOIS ORTHOPEDIC CENTER,LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	7002421	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	066440	OTHER		HEALTH ALLIANCE
2	1458	OTHER	IL	BC/BS
3	441874	OTHER		HEALTHLINK
4	133621000	OTHER		US DEPT OF LABOR

General Provider Information

NPI Number	:	1023001377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN ILLINOIS ORTHOPEDIC CENTER,LLC

Provider Business Mailing Address
First Line	:	600 S CLIFF AVE STE 106
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57104-5355
Country	:	US
Telephone Number	:	618-997-3100
Fax Number	:	618-997-3616

Provider Business Practice Location Address
First Line	:	510 LINCOLN DR
Second Line	:
City	:	HERRIN
State	:	IL
Zip	:	62948-6334
Country	:	US
Telephone Number	:	618-997-3100
Fax Number	:	618-997-3616

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	JUSTIN HARRIS
Credential	:	MSHA, MBA, FACHE
Telephone Number	:	859-537-7001

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	05/28/2024

Similar Medicare Providers

1205831971 — LOGAN PARK IMAGING LLC
Practice Location Address:

500 LINCOLN DR , STE C
HERRIN, IL
62948-6334

Practice Phone: 618-998-9633
Practice Fax: 618-998-9623

1881691756 — DR. WROPHAS MEEKS MD
Practice Location Address:

500 LINCOLN DR , STE C
HERRIN, IL
62948-6334

Practice Phone: 618-998-9633
Practice Fax: 618-998-9623

1922008754 — BRET HUNTER MILLER M.D.
Practice Location Address:

510 LINCOLN DRIVE
HERRIN, IL
62948-6334

Practice Phone: 618-997-6800
Practice Fax: 618-998-9635

1245229111 — GRETCHEN B MASON PA-C
Practice Location Address:

510 LINCOLN DR
HERRIN, IL
62948-6334

Practice Phone: 618-997-6800
Practice Fax: 618-998-9124

1295724110 — JOAN K. SCHULLIAN CRNA
Practice Location Address:

510 LINCOLN DR
HERRIN, IL
62948-6334

Practice Phone: 618-457-5111
Practice Fax: 618-457-6560

1245288802 — MRS. MESHIA K HUGHES PA-C
Practice Location Address:

510 LINCOLN DR
HERRIN, IL
62948-6334

Practice Phone: 618-997-6800
Practice Fax: 618-997-1187

Directions to “SOUTHERN ILLINOIS ORTHOPEDIC CENTER,LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.