Organization
COMPREHENSIVE ORTHOPEDICS, P. C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GEORGE W. LANE SR. M.D. (PRESIDENT)
(309) 692-6644
Entity
Organization
Contact information
Practice address
5401 NORTH KNOXVILLE AVE, SUITE 400, PEORIA, IL 61614-5021
(309) 692-6644
(309) 692-8992
Mailing address
5401 NORTH KNOXVILLE AVE, SUITE 400, PEORIA, IL 61614-5021
(309) 692-6644
(309) 692-8992
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
05
—
060007948
—
IL
01
—
368270100
OWCP DEPARTMENT OF LABORR
IL
01
—
7230175
BLUE CROSS BLUE SHIELD
IL
01
—
CH8612
RR MEDICARE
IL
Enumeration date
05/01/2009
Last updated
03/18/2010
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