Provider Demographics
NPI:1073849816
Name:CPO SERVICES, INC
Entity Type:Organization
Organization Name:CPO SERVICES, INC
Other - Org Name:COMPREHENSIVE PROSTHETICS AND ORTHOTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:GOERTZEN
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:309-676-2276
Mailing Address - Street 1:416 NE SAINT MARK CT
Mailing Address - Street 2:SUITE 310
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61603-3742
Mailing Address - Country:US
Mailing Address - Phone:309-676-2276
Mailing Address - Fax:
Practice Address - Street 1:2703 MCGRAW DR
Practice Address - Street 2:SUITE 3
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704
Practice Address - Country:US
Practice Address - Phone:309-676-2276
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CPO SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-10-29
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Z00000X, 335E00000X
IL213-000118224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty