Provider Demographics
NPI:1013269547
Name:ADVANCED ORTHOPEDIC AND SPINE CARE SC
Entity Type:Organization
Organization Name:ADVANCED ORTHOPEDIC AND SPINE CARE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TROY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-599-5000
Mailing Address - Street 1:PO BOX 825
Mailing Address - Street 2:
Mailing Address - City:BEDFORD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60499-0825
Mailing Address - Country:US
Mailing Address - Phone:708-599-5000
Mailing Address - Fax:708-599-5000
Practice Address - Street 1:16255 S. HARLEM AVE
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477
Practice Address - Country:US
Practice Address - Phone:708-599-5000
Practice Address - Fax:708-599-0801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-08
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL7663Medicare PIN
IL6725290001Medicare NSC
ILIL7664Medicare PIN