Healthcare Provider Details

I. General information

NPI: 1154300572
Provider Name (Legal Business Name): ORTHOPAEDIC CENTER OF IL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 S KOKE MILL RD
SPRINGFIELD IL
62711-9252
US

IV. Provider business mailing address

PO BOX 9469
SPRINGFIELD IL
62791-9469
US

V. Phone/Fax

Practice location:
  • Phone: 217-547-9100
  • Fax:
Mailing address:
  • Phone: 217-547-9132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY A VANFLEET
Title or Position: BOARD PRESIDENT
Credential: MD
Phone: 217-547-9100