Healthcare Provider Details

I. General information

NPI: 1760457204
Provider Name (Legal Business Name): ORTHOPAEDIC SURGERY CENTER OF ILLINOIS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2006
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3136 OLD JACKSONVILLE RD SUITE 250
SPRINGFIELD IL
62704-6487
US

IV. Provider business mailing address

3136 OLD JACKSONVILLE RD STE 250
SPRINGFIELD IL
62704-6487
US

V. Phone/Fax

Practice location:
  • Phone: 217-862-0500
  • Fax:
Mailing address:
  • Phone: 217-862-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number7002306
License Number StateIL

VIII. Authorized Official

Name: LEXANNE DARWENT
Title or Position: DIRECTOR
Credential: MBA, BSN, RN, CNOR
Phone: 217-862-0500