Provider Demographics
NPI:1255465076
Name:EDISON MEDICAL CORPORATION
Entity Type:Organization
Organization Name:EDISON MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EDEDEM
Authorized Official - Middle Name:E
Authorized Official - Last Name:EDEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-880-0445
Mailing Address - Street 1:9894 BISSONNET ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8239
Mailing Address - Country:US
Mailing Address - Phone:832-880-0445
Mailing Address - Fax:
Practice Address - Street 1:9894 BISSONNET ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8239
Practice Address - Country:US
Practice Address - Phone:832-880-0445
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0065659332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies