Provider Demographics
NPI:1245381441
Name:EDWARDS, JOEL A (MS)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:A
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2136
Mailing Address - Country:US
Mailing Address - Phone:402-280-8100
Mailing Address - Fax:402-280-8103
Practice Address - Street 1:425 N 30TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2100
Practice Address - Country:US
Practice Address - Phone:402-452-5000
Practice Address - Fax:402-452-5028
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE89231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3948794Medicaid
IA9948794Medicaid
IA2948794Medicaid
IA7948794Medicaid
IA8948794Medicaid
IA4948794Medicaid
NE100250041-00Medicaid
NE36801OtherBCBS BT
NE06614OtherBCBS ENT
NE100250037-00Medicaid
IA1585745Medicaid
IA2585745Medicaid
IA5948794Medicaid
IA0585745Medicaid
IA1948794Medicaid
IA3585745Medicaid
IA4585745Medicaid
IA6948794Medicaid
NE06614OtherBCBS ENT
IA1948794Medicaid