1245634898 NPI number — CPO SERVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245634898 NPI number — CPO SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CPO SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COMPREHENSIVE PROSTHETICS AND ORTHOTICS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245634898
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
741 W MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEORIA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61606-1953
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-334-5705
Provider Business Mailing Address Fax Number:
888-663-6322

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1010 JORIE BLVD STE 24
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAK BROOK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60523-4450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-897-6363
Provider Business Practice Location Address Fax Number:
630-897-7663
Provider Enumeration Date:
10/10/2014

Additional Information

Authorized Official

Authorized Official Last Name:
GOERTZEN
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
309-676-2276

Provider Taxonomy Codes

  • Taxonomy code: 335E00000X , with the licence number:  211-000147 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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