Provider Demographics
NPI:1073081436
Name:ORLAND PARK ORTHOPEDICS SC
Entity Type:Organization
Organization Name:ORLAND PARK ORTHOPEDICS SC
Other - Org Name:ORLAND PARK ORTHOPEDICS - PEORIA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAIR
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:RHODE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-337-7704
Mailing Address - Street 1:110 W MCCLURE AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61604-3634
Mailing Address - Country:US
Mailing Address - Phone:309-419-8996
Mailing Address - Fax:
Practice Address - Street 1:110 W MCCLURE AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61604-3634
Practice Address - Country:US
Practice Address - Phone:309-419-8996
Practice Address - Fax:309-966-3928
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORLAND PARK ORTHOPEDICS SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-05
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center