Basic Information
| Provider Information | |||||||||
| NPI: | 1952469454 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ORTHOPAEDIC ASSOCIATES OF RIVERSIDE,LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 353 E BURLINGTON ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | RIVERSIDE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605462189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084420221 | ||||||||
| FaxNumber: | 7084425670 | ||||||||
| Practice Location | |||||||||
| Address1: | 353 E BURLINGTON ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | RIVERSIDE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605462189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7084420221 | ||||||||
| FaxNumber: | 7084425670 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 02/04/2014 | ||||||||
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| AuthorizedOfficialLastName: | SLECHTA | ||||||||
| AuthorizedOfficialFirstName: | KATHI | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7084420221 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0114X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery |
No ID Information.