Provider Demographics
NPI:1417328709
Name:EDGE MEDICAL MARKETING LLC
Entity Type:Organization
Organization Name:EDGE MEDICAL MARKETING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-418-2613
Mailing Address - Street 1:6586 HYPOLUXO RD
Mailing Address - Street 2:STE 264
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7678
Mailing Address - Country:US
Mailing Address - Phone:954-418-2613
Mailing Address - Fax:561-828-3372
Practice Address - Street 1:6586 HYPOLUXO RD
Practice Address - Street 2:STE 264
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-7678
Practice Address - Country:US
Practice Address - Phone:954-418-2613
Practice Address - Fax:561-828-3372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization