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General NPI Number Information
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NPI Number | 1154721785
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Entity Type | Organization
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Legal Business Name | PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES - MIDWEST, LLC
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Dates
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Enumeration Date | 09/02/2014
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 215 RADIO DR STE 100
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City | WOODBURY
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State | MN
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Zip | 55125-5817
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Country | US
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Telephone | 612-593-6205
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Fax | 612-335-5396
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Provider Business Mailing Address
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Address Line | PO BOX 947109
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City | ATLANTA
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State | GA
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Zip | 30394-7109
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Country | US
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Telephone | 813-367-2876
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Fax | 813-518-7659
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Authorized Official
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Title or Position | MANAGER
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Name | MR. JEFFREY J BRUCE
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Credential | CPO
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Telephone | 612-596-6205
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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