Provider Demographics
NPI:1134493349
Name:HARVEY L. EDMONDS, M.D. INC
Entity Type:Organization
Organization Name:HARVEY L. EDMONDS, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:EDMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-436-9800
Mailing Address - Street 1:728 E BALLARD AVENUE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710
Mailing Address - Country:US
Mailing Address - Phone:559-436-9800
Mailing Address - Fax:559-436-9804
Practice Address - Street 1:728 E BALLARD AVENUE
Practice Address - Street 2:SUITE 104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710
Practice Address - Country:US
Practice Address - Phone:559-436-9800
Practice Address - Fax:559-436-9804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG247252084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G247250OtherMEDICAL PROV NO
4136936OtherMEDICAL UPIN
4136936OtherMEDICAL UPIN
A42358Medicare UPIN