Healthcare Provider Details

I. General information

NPI: 1578890976
Provider Name (Legal Business Name): CPO SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2009
Last Update Date: 07/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 ROCK ST SUITE D2
PERU IL
61354
US

IV. Provider business mailing address

416 NE SAINT MARK CT SUITE 310
PEORIA IL
61603-3742
US

V. Phone/Fax

Practice location:
  • Phone: 888-676-2276
  • Fax:
Mailing address:
  • Phone: 309-676-2276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number213-000118
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number213-000118
License Number StateIL

VIII. Authorized Official

Name: MR. DONALD GOERTZEN
Title or Position: PRESIDENT
Credential: CPO
Phone: 309-676-2276