Provider Demographics
NPI:1710908058
Name:CENTRAL ILLINOIS ORTHOPEDIC SURGERY S.C.
Entity type:Organization
Organization Name:CENTRAL ILLINOIS ORTHOPEDIC SURGERY S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:NORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-662-2278
Mailing Address - Street 1:1505 EASTLAND DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-3534
Mailing Address - Country:US
Mailing Address - Phone:309-662-2278
Mailing Address - Fax:309-663-2956
Practice Address - Street 1:1505 EASTLAND DR
Practice Address - Street 2:SUITE 220
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61701-3534
Practice Address - Country:US
Practice Address - Phone:309-662-2278
Practice Address - Fax:309-663-2956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty