Provider Demographics
NPI:1073890588
Name:EDSON MEDICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:EDSON MEDICAL ASSOCIATES LLC
Other - Org Name:PCA OF BATTLE CREEK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:EDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:801-243-7082
Mailing Address - Street 1:2845 CAPITAL AVE SW STE 202
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-4186
Mailing Address - Country:US
Mailing Address - Phone:801-243-7082
Mailing Address - Fax:
Practice Address - Street 1:2845 CAPITAL AVE SW STE 202
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-4186
Practice Address - Country:US
Practice Address - Phone:269-223-7045
Practice Address - Fax:269-282-0758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-11
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty