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General NPI Number Information
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NPI Number | 1578937876
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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 | 11/24/2015
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 110 CONN TER
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City | LEXINGTON
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State | KY
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Zip | 40508-3206
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Country | US
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Telephone | 859-268-5649
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Fax | 859-268-5714
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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. ERIC LEE MILLER
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Credential | CPO-L
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Telephone | 859-268-5708
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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 | LPO-101
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License Number State | KY
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