ADVANCED ORTHOPEDICS PC NPI 1508924051

NPI Information

NPI: 1508924051
Provider Name: ADVANCED ORTHOPEDICS, PC
Classification: Specialist - 174400000X
Entity Type: Organization
Address: 5401 N KNOXVILLE AVE
SUITE 400
PEORIA, IL
ZIP 61614
Phone: (309) 692-6644

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NPI Details

ADVANCED ORTHOPEDICS, PC is a specialist in Peoria, IL. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. ADVANCED ORTHOPEDICS, PC NPI is 1508924051. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

5401 N KNOXVILLE AVE
SUITE 400
PEORIA, IL
ZIP 61614-098
Phone: (309) 692-6644
Fax: (309) 692-3052

The provider's authorized official is George W. Lane .
The authorized official title is President and has the following contact phone number (309) 692-6644.

The enumeration date for this NPI number is 12/5/2006 and was last updated on 12/12/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	174400000X	Specialist		060007948	ILLINOIS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	707840	MEDICARE PIN	ILLINOIS
2	050053	OTHER	ILLINOIS	HEALTH ALLIANCE
3	060007948	OTHER	ILLINOIS	STATE LICENSE
4	CH8612	OTHER	ILLINOIS	RR MEDICARE
5	7230175	OTHER	ILLINOIS	BLUE CROSS BLUE SHIELD
6	368270100	OTHER	ILLINOIS	OWCP DEPARTMENT OF LABOR

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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