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General NPI Number Information
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NPI Number | 1346424728
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Entity Type | Organization
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Legal Business Name | CENTER FOR ORTHOTIC & PROSTHETIC EXCELLENCE, LLC
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Dates
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Enumeration Date | 12/20/2007
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Last Update Date | 09/24/2024
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Provider Practice Location Address
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Address Line | 9615 KEILMAN ST SUITE 200
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City | SAINT JOHN
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State | IN
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Zip | 46373
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Country | US
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Telephone | 219-365-0248
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Fax | 219-365-0072
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Provider Business Mailing Address
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Address Line | 741 W MAIN STREET
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City | PEORIA
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State | IL
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Zip | 61606
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Country | US
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Telephone | 309-676-2276
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Fax | 888-663-6322
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Authorized Official
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Title or Position | CEO
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Name | MR. AMIT BHANTI
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Credential | CPO
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Telephone | 309-676-2276
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State | IN
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