Provider Demographics
NPI:1578880167
Name:PEDIATRIC PRODUCTS, LLC
Entity Type:Organization
Organization Name:PEDIATRIC PRODUCTS, LLC
Other - Org Name:XPRESS NEBS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAULSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-891-4633
Mailing Address - Street 1:10679 MCSWAIN DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-3168
Mailing Address - Country:US
Mailing Address - Phone:513-891-4633
Mailing Address - Fax:
Practice Address - Street 1:225 N MEMORIAL DR
Practice Address - Street 2:SUITE #8
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36067-3344
Practice Address - Country:US
Practice Address - Phone:334-365-3373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL5398750006Medicare NSC