Provider Demographics
NPI:1407904840
Name:JSC PEDORTHICS INC.
Entity Type:Organization
Organization Name:JSC PEDORTHICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:D
Authorized Official - Last Name:REEDY
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:386-437-0272
Mailing Address - Street 1:100 S STATE ST STE D
Mailing Address - Street 2:
Mailing Address - City:BUNNELL
Mailing Address - State:FL
Mailing Address - Zip Code:32110-6115
Mailing Address - Country:US
Mailing Address - Phone:386-437-0272
Mailing Address - Fax:386-437-0272
Practice Address - Street 1:100 S STATE ST STE D
Practice Address - Street 2:
Practice Address - City:BUNNELL
Practice Address - State:FL
Practice Address - Zip Code:32110-6115
Practice Address - Country:US
Practice Address - Phone:386-437-0272
Practice Address - Fax:386-437-0272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPED 53335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4753490002Medicare NSC
FL4753490001Medicare NSC