Provider Demographics
NPI:1366726457
Name:PEDICARE LLC
Entity type:Organization
Organization Name:PEDICARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PERLA
Authorized Official - Middle Name:E
Authorized Official - Last Name:TAMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-648-2543
Mailing Address - Street 1:421 S 12TH ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-4923
Mailing Address - Country:US
Mailing Address - Phone:956-648-2543
Mailing Address - Fax:
Practice Address - Street 1:3141 CENTER POINT DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8433
Practice Address - Country:US
Practice Address - Phone:956-688-5781
Practice Address - Fax:956-688-6114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation