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General NPI Number Information
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NPI Number | 1568602480
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Entity Type | Organization
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Legal Business Name | PREMIER ORTHOPAEDIC AND HAND CENTER, SC
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Dates
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Enumeration Date | 03/05/2009
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Last Update Date | 11/04/2025
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Provider Practice Location Address
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Address Line | 19801 GOVERNORS HIGHWAY SUITE 160
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City | FLOSSMOOR
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State | IL
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Zip | 60422-7834
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Country | US
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Telephone | 708-957-0505
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Fax | 708-957-0506
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Provider Business Mailing Address
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Address Line | 19801 GOVERNORS HWY STE 160
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City | FLOSSMOOR
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State | IL
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Zip | 60422-7834
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Country | US
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Telephone | 708-957-0505
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Fax | 708-957-0506
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | WENDI JEFFERS
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Credential |
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Telephone | 708-957-0505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 042619353
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License Number State | IL
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