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
—
—
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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