Healthcare Provider Details

I. General information

NPI: 1710202056
Provider Name (Legal Business Name): CPO SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 N. WOODFORD STREET
DECATUR IL
62526
US

IV. Provider business mailing address

741 W MAIN ST
PEORIA IL
61606-1953
US

V. Phone/Fax

Practice location:
  • Phone: 217-619-0069
  • Fax: 217-875-7038
Mailing address:
  • Phone: 800-334-5705
  • Fax: 888-663-6322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number213000118
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number211000225
License Number StateIL

VIII. Authorized Official

Name: AMIT BHANTI
Title or Position: CEO
Credential: CP, LPO
Phone: 309-676-2276