Provider Demographics
NPI:1144617077
Name:EDGE-MD WEST, PLLC
Entity Type:Organization
Organization Name:EDGE-MD WEST, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-532-2000
Mailing Address - Street 1:6018 WEST AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CASTLE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78213-2729
Mailing Address - Country:US
Mailing Address - Phone:210-979-8478
Mailing Address - Fax:210-979-8548
Practice Address - Street 1:6018 WEST AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:CASTLE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78213-2729
Practice Address - Country:US
Practice Address - Phone:210-979-8478
Practice Address - Fax:210-979-8548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0318207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty