Provider Demographics
NPI:1568891489
Name:EDGE WELLNESS, INC
Entity Type:Organization
Organization Name:EDGE WELLNESS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESS
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-843-7517
Mailing Address - Street 1:17819 STUEBNER AIRLINE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-5419
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17819 STUEBNER AIRLINE RD
Practice Address - Street 2:SUITE C
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-5419
Practice Address - Country:US
Practice Address - Phone:832-843-7517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health