Provider Demographics
NPI:1740518620
Name:TENDERCARE PEDI SUPPLY
Entity type:Organization
Organization Name:TENDERCARE PEDI SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BURGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-669-9632
Mailing Address - Street 1:610 GREENHILL DR
Mailing Address - Street 2:#11203
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-2200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:610 GREENHILL DR
Practice Address - Street 2:#11203
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-2200
Practice Address - Country:US
Practice Address - Phone:903-669-9632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-03
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies