Provider Demographics
NPI:1750574182
Name:PEDORTHIC SPECIALISTS LLC
Entity type:Organization
Organization Name:PEDORTHIC SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCHMIDTBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:C-PED
Authorized Official - Phone:785-625-3529
Mailing Address - Street 1:709 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-4438
Mailing Address - Country:US
Mailing Address - Phone:785-625-3529
Mailing Address - Fax:785-625-3529
Practice Address - Street 1:709 MAIN ST
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-4438
Practice Address - Country:US
Practice Address - Phone:785-625-3529
Practice Address - Fax:785-625-3529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSNA332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1175770001Medicare NSC