Provider Demographics
NPI:1760097059
Name:EDWARDS, JASON DANIEL
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:DANIEL
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10979 COMANCHE DR
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-9587
Mailing Address - Country:US
Mailing Address - Phone:937-726-3028
Mailing Address - Fax:
Practice Address - Street 1:10979 COMANCHE DR
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-9587
Practice Address - Country:US
Practice Address - Phone:937-726-3028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-13
Last Update Date:2020-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0085422Medicaid