Provider Demographics
NPI:1477637601
Name:PEDORTHIC CONCEPTS, INC
Entity Type:Organization
Organization Name:PEDORTHIC CONCEPTS, INC
Other - Org Name:THE FOOTCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:205-823-5580
Mailing Address - Street 1:3021 LORNA RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35216-4587
Mailing Address - Country:US
Mailing Address - Phone:205-823-5580
Mailing Address - Fax:205-823-5590
Practice Address - Street 1:3021 LORNA RD
Practice Address - Street 2:SUITE 300
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35216-4587
Practice Address - Country:US
Practice Address - Phone:205-823-5580
Practice Address - Fax:205-823-5590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51514840OtherBLUE CROSS BLUE SHIELD