Provider Demographics
NPI:1467472316
Name:MEDICAL EDGE HEALTHCARE GROUP PA
Entity Type:Organization
Organization Name:MEDICAL EDGE HEALTHCARE GROUP PA
Other - Org Name:ROSEMEADE DIAGNOSTIC IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLAY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIGHTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-739-3001
Mailing Address - Street 1:9229 LYNDON B JOHNSON FWY
Mailing Address - Street 2:STE. 250
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-3405
Mailing Address - Country:US
Mailing Address - Phone:972-739-3637
Mailing Address - Fax:972-739-2673
Practice Address - Street 1:2117 E ROSEMEADE PKWY
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-2303
Practice Address - Country:US
Practice Address - Phone:972-395-7533
Practice Address - Fax:972-937-2246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081500303Medicaid
TXFTX190Medicare PIN
TX081500303Medicaid
TXX13198Medicare UPIN