Organization
ADVANCED ORTHOPEDICS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE W. LANE SR. MD (PRESIDENT)
(309) 692-6644
Entity
Organization
Contact information
Practice address
5401 N KNOXVILLE AVE, SUITE 400, PEORIA, IL 61614-5098
(309) 692-6644
(309) 692-3052
Mailing address
5401 N KNOXVILLE AVE, SUITE 400, PEORIA, IL 61614-5098
(309) 692-6644
(309) 692-3052
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
060007948
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050053
HEALTH ALLIANCE
IL
01
—
060007948
STATE LICENSE
IL
01
—
368270100
OWCP DEPARTMENT OF LABOR
IL
01
—
7230175
BLUE CROSS BLUE SHIELD
IL
01
—
CH8612
RR MEDICARE
IL
Enumeration date
12/05/2006
Last updated
12/12/2007
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