Provider Demographics
NPI:1316171739
Name:ASSOCIATED ORTHOPEDICS SC
Entity type:Organization
Organization Name:ASSOCIATED ORTHOPEDICS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:F
Authorized Official - Last Name:TRAINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-243-8500
Mailing Address - Street 1:10326 N JULIET CT
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1199
Mailing Address - Country:US
Mailing Address - Phone:309-243-8500
Mailing Address - Fax:
Practice Address - Street 1:10326 N JULIET CT
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-1199
Practice Address - Country:US
Practice Address - Phone:309-243-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-13
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL6271610001Medicare NSC