Provider Demographics
NPI:1295747863
Name:WATSON ORTHOPAEDICS LLC
Entity type:Organization
Organization Name:WATSON ORTHOPAEDICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-523-0808
Mailing Address - Street 1:320 E CARPENTER ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-5185
Mailing Address - Country:US
Mailing Address - Phone:217-523-0808
Mailing Address - Fax:217-523-9859
Practice Address - Street 1:320 E CARPENTER ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-5185
Practice Address - Country:US
Practice Address - Phone:217-523-0808
Practice Address - Fax:217-523-9859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty