Provider Demographics
NPI:1669464749
Name:EDIMAX MEDICAL RESOURCE
Entity Type:Organization
Organization Name:EDIMAX MEDICAL RESOURCE
Other - Org Name:EDIMAX MEDICAL RESOURCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:O
Authorized Official - Last Name:ESIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-278-4440
Mailing Address - Street 1:3228 SOUTHERN DR
Mailing Address - Street 2:SUITE 204-D
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-1579
Mailing Address - Country:US
Mailing Address - Phone:972-278-4440
Mailing Address - Fax:972-926-9574
Practice Address - Street 1:3228 SOUTHERN DR
Practice Address - Street 2:SUITE 204-D
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-1579
Practice Address - Country:US
Practice Address - Phone:972-278-4440
Practice Address - Fax:972-926-9574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1586661-01Medicaid
TX1586661-02Medicaid
SC4796680001Medicare ID - Type Unspecified