Provider Demographics
NPI:1083647671
Name:PLATTNER PEDORTHIC SERVICES
Entity Type:Organization
Organization Name:PLATTNER PEDORTHIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:PLATTNER
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:309-682-1382
Mailing Address - Street 1:311 W ROMEO B GARRETT AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61605-2504
Mailing Address - Country:US
Mailing Address - Phone:309-682-1382
Mailing Address - Fax:309-682-7125
Practice Address - Street 1:311 W ROMEO B GARRETT AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61605-2504
Practice Address - Country:US
Practice Address - Phone:309-682-1382
Practice Address - Fax:309-682-7125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL=========001Medicaid
IL07232049Medicare UPIN