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General NPI Number Information
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NPI Number | 1902040124
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE ORTHOPEDICS, P. C.
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Dates
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Enumeration Date | 05/01/2009
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Last Update Date | 03/18/2010
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Provider Practice Location Address
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Address Line | 5401 NORTH KNOXVILLE AVE SUITE 400
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City | PEORIA
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State | IL
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Zip | 61614-5021
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Country | US
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Telephone | 309-692-6644
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Fax | 309-692-8992
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Provider Business Mailing Address
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Address Line | 5401 NORTH KNOXVILLE AVE SUITE 400
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City | PEORIA
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State | IL
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Zip | 61614-5021
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Country | US
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Telephone | 309-692-6644
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Fax | 309-692-8992
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GEORGE W. LANE SR.
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Credential | M.D.
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Telephone | 309-692-6644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 060007948
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License Number State | IL
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