Provider Demographics
NPI:1699900548
Name:PEDIATRIC PRODUCTS, LLC
Entity type:Organization
Organization Name:PEDIATRIC PRODUCTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RONI
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-891-4633
Mailing Address - Street 1:2975 EXON AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45241-2520
Mailing Address - Country:US
Mailing Address - Phone:513-891-4633
Mailing Address - Fax:513-891-4654
Practice Address - Street 1:3209 W SMITH VALLEY RD
Practice Address - Street 2:#217-4
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-8510
Practice Address - Country:US
Practice Address - Phone:317-884-5035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-21
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
IN200503130AMedicaid
IN5398750005Medicare NSC