Provider Demographics
NPI:1457646051
Name:POMPANO BEACH MEDICAL CORP
Entity Type:Organization
Organization Name:POMPANO BEACH MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:EDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-601-2974
Mailing Address - Street 1:750 E SAMPLE RD
Mailing Address - Street 2:BLDG 1 UNIT 5
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-5144
Mailing Address - Country:US
Mailing Address - Phone:954-601-2974
Mailing Address - Fax:954-783-1080
Practice Address - Street 1:750 E SAMPLE RD
Practice Address - Street 2:BLDG 1 UNIT 5
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-5144
Practice Address - Country:US
Practice Address - Phone:954-601-2974
Practice Address - Fax:954-783-1080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty