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Organization
THE CENTER FOR ADVANCED ORTHOPEDICS, LLC
Active
Organization
THE CENTER FOR ADVANCED ORTHOPEDICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIERNEY RILEY (PRACTICE MANAGER)
(618) 288-9460
Entity
Organization
Contact information
Practice address
6812 STATE RTE 162, 123, MARYVILLE, IL 62062-8500
(618) 288-9460
Mailing address
6812 STATE ROUTE 162, 123, MARYVILLE, IL 62062
(618) 288-9460
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
NULL
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036110043003
—
IL
Enumeration date
12/13/2007
Last updated
07/08/2010
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