Provider Demographics
NPI:1710136973
Name:EDNA OF TEXAS
Entity Type:Organization
Organization Name:EDNA OF TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:FATIMAH
Authorized Official - Middle Name:ADEYEMI
Authorized Official - Last Name:SHITTU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-494-9366
Mailing Address - Street 1:1907 SUMMERFIELD PL
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-2555
Mailing Address - Country:US
Mailing Address - Phone:281-494-9366
Mailing Address - Fax:
Practice Address - Street 1:1907 SUMMERFIELD PL
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-2555
Practice Address - Country:US
Practice Address - Phone:281-494-9366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization