Provider Demographics
NPI:1023045325
Name:PEDICURE, LLC
Entity Type:Organization
Organization Name:PEDICURE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-276-3030
Mailing Address - Street 1:250 TRACE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35244-3924
Mailing Address - Country:US
Mailing Address - Phone:205-276-3030
Mailing Address - Fax:205-982-7931
Practice Address - Street 1:250 TRACE RIDGE RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-3924
Practice Address - Country:US
Practice Address - Phone:205-276-3030
Practice Address - Fax:205-982-7931
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51518919OtherBLUE CROSS
4769520001Medicare ID - Type Unspecified