Provider Demographics
NPI:1710202056
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:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:GOERTZEN
Authorized Official - Suffix:
Authorized Official - Credentials:CP, LPO
Authorized Official - Phone:800-334-5705
Mailing Address - Street 1:741 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61606-1953
Mailing Address - Country:US
Mailing Address - Phone:800-334-5705
Mailing Address - Fax:888-663-6322
Practice Address - Street 1:3030 N. WOODFORD STREET
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526
Practice Address - Country:US
Practice Address - Phone:217-619-0069
Practice Address - Fax:217-875-7038
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CPO SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213000118222Z00000X
IL211000225224P00000X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotistGroup - Multi-Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5599320005Medicare NSC