Provider Demographics
NPI:1275308991
Name:EDWARDS DFW
Entity Type:Organization
Organization Name:EDWARDS DFW
Other - Org Name:EDWARDS MEDICAL GROUP DFW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVENUE CYCLE ADMIN
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:BLAIR
Authorized Official - Last Name:ELDER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:737-247-1223
Mailing Address - Street 1:2205 CORDILLERA WAY
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-6290
Mailing Address - Country:US
Mailing Address - Phone:737-247-1223
Mailing Address - Fax:
Practice Address - Street 1:5637 N TARRANT PKWY STE B
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-7321
Practice Address - Country:US
Practice Address - Phone:855-934-1178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-22
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty