Provider Demographics
NPI:1023568656
Name:EDGE MEDICAL SERVICES
Entity Type:Organization
Organization Name:EDGE MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-348-4623
Mailing Address - Street 1:1141 N LOOP 1604 E # 105187
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1339
Mailing Address - Country:US
Mailing Address - Phone:800-348-4623
Mailing Address - Fax:800-391-4146
Practice Address - Street 1:1190 E 5425 S
Practice Address - Street 2:330
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-4548
Practice Address - Country:US
Practice Address - Phone:800-348-4623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EDGE MEDICAL SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-06
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing