Prosthetic Orthotic Specialist Inc

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

PROSTHETIC ORTHOTIC SPECIALIST INC

Practice address

701 NE Jefferson Ave
Peoria, IL 61603

Phone

(309) 688-9549

Fax

(309) 676-0486

NPI assigned

Oct 9, 2005

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

  • Prosthetist
  • Decatur, IL
  • NPI 1710202056

  Member Of

  NPD member

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Prosthetic Orthotic Specialist Inc

  • Prosthetic/Orthotic Supplier
  • Decatur, IL
  • NPI 1710118864
  NPPES parent name

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

{
    "created_epoch": "1128816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532908800000",
    "number": "1851389449",
    "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": "309-676-2276",
            "fax_number": "309-676-0486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 NE JEFFERSON AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "61603",
            "telephone_number": "309-688-9549",
            "fax_number": "309-676-0486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROSTHETIC ORTHOTIC SPECIALIST INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-09",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "05770602",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Professional Therapy Services
• Professional Therapy Services, Inc.
• Professional Therapy Services, Inc.
• Kara S Prohaska, DEVL THERAPIST
• Ute Prohaska, M.D.
• Provisionii Behaviorial Health LLC
• Kate Pruis
• Matthew Scott Pruitt, PHARMD
• Jill Anne Pruvost, M.S., CCC-A
• Jeremy William Przybylo, PT

• All providers in Peoria, IL
• 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.