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General NPI Number Information
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NPI Number | 1427222470
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Entity Type | Organization
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Legal Business Name | PEDORTHIC CARE, LLC
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Dates
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Enumeration Date | 04/21/2008
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Last Update Date | 06/02/2010
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Provider Practice Location Address
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Address Line | 3141 LORNA RD SUITE 100
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City | HOOVER
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State | AL
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Zip | 35216-5416
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Country | US
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Telephone | 205-822-1606
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Fax | 205-822-9756
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Provider Business Mailing Address
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Address Line | 3141 LORNA RD SUITE 100
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City | HOOVER
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State | AL
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Zip | 35216-5416
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Country | US
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Telephone | 205-822-1606
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Fax | 205-822-9756
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL DUVDEVANI
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Credential |
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Telephone | 205-822-1606
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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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