Organization
PROSTHETIC ORTHOTIC SPECIALIST INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD GOERTZEN CPO (PRESIDENT)
(309) 676-2276
Entity
Organization
Contact information
Practice address
701 NE JEFFERSON AVE, PEORIA, IL 61603
(309) 688-9549
(309) 676-0486
Mailing address
741 W MAIN ST, PEORIA, IL 61606-1953
(309) 676-2276
(309) 676-0486
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05770602
BLUE CROSS BLUE SHIELD
IL
Enumeration date
10/09/2005
Last updated
07/30/2018
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