Provider Demographics
NPI:1013148238
Name:PED NEGOTIUM INC.
Entity Type:Organization
Organization Name:PED NEGOTIUM INC.
Other - Org Name:TENDERFEET SHOES/INCARE DME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:714-990-5932
Mailing Address - Street 1:1050 W CENTRAL AVE STE D
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-2200
Mailing Address - Country:US
Mailing Address - Phone:714-990-5932
Mailing Address - Fax:714-990-4060
Practice Address - Street 1:1220 PIONEER ST STE F
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3712
Practice Address - Country:US
Practice Address - Phone:657-229-3079
Practice Address - Fax:714-990-4060
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PED NEGOTIUM INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-05
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS1389332B00000X
MDC49909335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6687430001Medicare NSC