Provider Demographics
NPI:1295861128
Name:PEDICONS, INC.
Entity Type:Organization
Organization Name:PEDICONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:255-667-2777
Mailing Address - Street 1:10130 CROSSING WAY STE 335
Mailing Address - Street 2:
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-5889
Mailing Address - Country:US
Mailing Address - Phone:225-667-2777
Mailing Address - Fax:225-667-0064
Practice Address - Street 1:10130 CROSSING WAY STE 335
Practice Address - Street 2:
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-5889
Practice Address - Country:US
Practice Address - Phone:225-667-2777
Practice Address - Fax:225-667-0064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4505167OtherSUBMITTER NUMBER
LA1947172Medicaid