Provider Demographics
NPI:1346701893
Name:EDSEL IWAY MD LLC
Entity Type:Organization
Organization Name:EDSEL IWAY MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDSEL
Authorized Official - Middle Name:
Authorized Official - Last Name:IWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-519-7300
Mailing Address - Street 1:2855 S BRONCO ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5207
Mailing Address - Country:US
Mailing Address - Phone:412-519-7300
Mailing Address - Fax:
Practice Address - Street 1:2900 W HORIZON RIDGE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5014
Practice Address - Country:US
Practice Address - Phone:702-487-7055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-27
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty