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General NPI Number Information
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NPI Number | 1609990944
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Entity Type | Organization
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Legal Business Name | REGIONAL ORTHOPAEDICS & SPORTS MEDICINE CENTER, LTD.
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 07/10/2008
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Provider Practice Location Address
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Address Line | 1600 W WALNUT ST
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City | JACKSONVILLE
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State | IL
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Zip | 62650-1136
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Country | US
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Telephone | 217-243-0033
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Fax | 217-245-1791
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Provider Business Mailing Address
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Address Line | 1600 W WALNUT ST
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City | JACKSONVILLE
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State | IL
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Zip | 62650-1136
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Country | US
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Telephone | 217-243-0033
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Fax | 217-245-1791
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Authorized Official
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Title or Position | PRESIDENT
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Name | DARR W LEUTZ
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Credential | M.D.
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Telephone | 217-243-0033
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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 | 036088511
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License Number State | IL
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