MEDICARE: PEDIATRIC PRODUCTS, LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912133026
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC PRODUCTS, LLC

Provider Business Mailing Address
First Line	:	10679 MCSWAIN DRIVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45241-3168
Country	:	US
Telephone Number	:	513-891-4633
Fax Number	:	513-891-4654

Provider Business Practice Location Address
First Line	:	201 NATURAL RESOURCES DRIVE
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72205-1575
Country	:	US
Telephone Number	:	888-721-6893
Fax Number	:	513-891-4654

Authorized Official
Title or Position	:	CEO
Name	:	RANDY PAULSON
Credential	:
Telephone Number	:	513-891-4633

Provider Enumeration Date	:	06/03/2009
Last Update Date	:	11/10/2022

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