Provider Demographics
NPI:1154661148
Name:BSEDMUND CORP.
Entity Type:Organization
Organization Name:BSEDMUND CORP.
Other - Org Name:EDMUND CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SARA
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:EDMUND
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-C
Authorized Official - Phone:480-654-2266
Mailing Address - Street 1:3614 E SOUTHERN AVE
Mailing Address - Street 2:SUITE A105
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-2509
Mailing Address - Country:US
Mailing Address - Phone:480-654-2266
Mailing Address - Fax:480-999-5636
Practice Address - Street 1:3614 E SOUTHERN AVE
Practice Address - Street 2:SUITE A 105
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2509
Practice Address - Country:US
Practice Address - Phone:480-654-2266
Practice Address - Fax:480-999-5636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-27
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4506363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty