Koebers Prosthetic & Orthotic Lab Inc.

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

KOEBERS PROSTHETIC & ORTHOTIC LAB INC.

Practice address

3834 W Irving Park Rd
Chicago, IL 60618

Phone

(773) 539-7333

Fax

(773) 539-5535

NPI assigned

Jan 10, 2007

Last updated

Jul 30, 2018By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Donald Goertzen, CPO

Title

President

Phone

(309) 676-2276

Specialties & licenses 1

Addresses

Other identifiers 1

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Cpo Services, Inc

  dba Comprehensive Prosthetics & Orthotics

  • Prosthetic/Orthotic Supplier
  • Quincy, IL
  • NPI 1295062594

  Member Of

  NPD member

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532908800000",
    "number": "1700936234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "741 W MAIN ST",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616061953",
            "telephone_number": "800-334-5705",
            "fax_number": "888-663-6322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3834 W IRVING PARK RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60618",
            "telephone_number": "773-539-7333",
            "fax_number": "773-539-5535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOEBERS PROSTHETIC & ORTHOTIC LAB INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-10",
        "last_updated": "2018-07-30",
        "status": "A",
        "authorized_official_last_name": "GOERTZEN",
        "authorized_official_first_name": "DONALD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "309-676-2276",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPO"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "01680020",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Allen Kodish, M.D.
• Varna Kumar Kodoth, MD
• Anuradha Koduri, M.D.
• Priyadarshini Koduri, M.D.
• Pramoda Koduru, M.D
• Melissa Beth Koehl, PT
• Koehler Chiropractic Center PC
• Christina Mary Koehler
• Emily D Koehler, LCSW
• Irmgard Kilb Koehler, MD

• Prosthetic/Orthotic Supplier in Chicago, IL
• Providers in Chicago, IL by specialty
• Prosthetic/Orthotic Supplier in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.