=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215612866
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CPO SERVICES, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2023
-----------------------------------------------------
Last Update Date | 06/21/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1710 N RANDALL RD STE 170
-----------------------------------------------------
City | ELGIN
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60123-9403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-201-2159
-----------------------------------------------------
Fax | 847-213-9394
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 741 W MAIN ST
-----------------------------------------------------
City | PEORIA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61606-1953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-285-7752
-----------------------------------------------------
Fax | 309-285-7752
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | AMIT V BHANTI
-----------------------------------------------------
Credential | LO
-----------------------------------------------------
Telephone | 309-676-2276
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------