# PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES - MIDWEST, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES - MIDWEST, LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1154721785
- **Legal business name:** PEDIATRIC ORTHOTIC AND PROSTHETIC SERVICES - MIDWEST, LLC
- **Authorized official:** MR. JEFFREY J BRUCE CPO (MANAGER)
- **Authorized official phone:** (612) 596-6205

## Contact information

- **Practice address:** 215 RADIO DR STE 100, WOODBURY, MN 55125-5817
- **Practice address phone:** (612) 593-6205
- **Practice address fax:** (612) 335-5396
- **Mailing address:** PO BOX 947109, ATLANTA, GA 30394-7109
- **Mailing address phone:** (813) 367-2876
- **Mailing address fax:** (813) 518-7659

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 335E00000X | Prosthetic/Orthotic Supplier | — | NULL | Yes |

## Other

- **Enumeration date:** 09/02/2014
- **Last updated:** 04/23/2025