Provider Demographics
NPI:1174573307
Name:CPO SERVICES, INC
Entity type:Organization
Organization Name:CPO SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:BHANTI
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:309-676-2276
Mailing Address - Street 1:741 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61606
Mailing Address - Country:US
Mailing Address - Phone:309-676-2276
Mailing Address - Fax:309-676-2279
Practice Address - Street 1:741 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61606
Practice Address - Country:US
Practice Address - Phone:309-676-2276
Practice Address - Fax:309-676-2279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL211-000147335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL07232129OtherBLUE CROSS BLUE SHEILD OF
IL07232129OtherBLUE CROSS BLUE SHEILD OF
IL5599320001Medicare NSC