MEDICARE: PEDI MASTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1336513803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDI MASTER INC

Provider Business Mailing Address
First Line	:	7637 BERMEJO RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112-6107
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7637 BERMEJO RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76112-6107
Country	:	US
Telephone Number	:	817-271-1393
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LARRY D MERCER
Credential	:
Telephone Number	:	817-271-1393

Provider Enumeration Date	:	11/21/2015
Last Update Date	:	11/21/2015

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Directions to “PEDI MASTER INC ” Practice Location

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