Provider Demographics
NPI:1114030640
Name:NEUROMUSCULAR ORTHOPAEDIC INSTITUTE LTD
Entity Type:Organization
Organization Name:NEUROMUSCULAR ORTHOPAEDIC INSTITUTE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:FROEHLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-242-4750
Mailing Address - Street 1:302 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-5116
Mailing Address - Country:US
Mailing Address - Phone:618-242-4750
Mailing Address - Fax:618-242-7674
Practice Address - Street 1:302 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864-5116
Practice Address - Country:US
Practice Address - Phone:618-242-4750
Practice Address - Fax:618-242-7674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042007509207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL27610OtherGHP
IL4100074OtherBLUE CROSS BLUE SHIELD
ILCN4164OtherRR MEDICARE
IL27610OtherGHP
IL4100074OtherBLUE CROSS BLUE SHIELD