Provider Demographics
NPI:1083009385
Name:HEALTH EDGE GROUP, LLC
Entity Type:Organization
Organization Name:HEALTH EDGE GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-607-3773
Mailing Address - Street 1:2102 OTRANTO BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9841
Mailing Address - Country:US
Mailing Address - Phone:843-569-2225
Mailing Address - Fax:843-863-1830
Practice Address - Street 1:2102 OTRANTO BLVD STE A
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9841
Practice Address - Country:US
Practice Address - Phone:843-569-2225
Practice Address - Fax:843-863-1830
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH EDGE GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9-14-119373332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP6680Medicaid