# THE CENTER FOR ADVANCED ORTHOPEDICS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588847446
- **Authorized official:** TIERNEY RILEY (PRACTICE MANAGER)
- **Authorized official phone:** (618) 288-9460

## Contact information

- **Practice address:** 6812 STATE RTE 162, 123, MARYVILLE, IL 62062-8500
- **Practice address phone:** (618) 288-9460
- **Mailing address:** 6812 STATE ROUTE 162, 123, MARYVILLE, IL 62062
- **Mailing address phone:** (618) 288-9460

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/13/2007
- **Last updated:** 07/08/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 036110043003 | — | IL |