Provider Demographics
NPI:1881716538
Name:PEDIATRIC PRODUCTS, LLC
Entity type:Organization
Organization Name:PEDIATRIC PRODUCTS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
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 DRIVE
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:513-891-4654
Practice Address - Street 1:1448 10TH AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-3579
Practice Address - Country:US
Practice Address - Phone:304-529-0025
Practice Address - Fax:513-891-4654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810006183Medicaid