Healthcare Provider Details

I. General information

NPI: 1750574182
Provider Name (Legal Business Name): PEDORTHIC SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 08/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 MAIN ST
HAYS KS
67601-4438
US

IV. Provider business mailing address

709 MAIN ST
HAYS KS
67601-4438
US

V. Phone/Fax

Practice location:
  • Phone: 785-625-3529
  • Fax: 785-625-3529
Mailing address:
  • Phone: 785-625-3529
  • Fax: 785-625-3529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberNA
License Number StateKS

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. KARL A SCHMIDTBERGER
Title or Position: MEMBER
Credential: C-PED
Phone: 785-625-3529