Provider Demographics
NPI:1811217367
Name:TED L EDWARDS JR MD PA
Entity Type:Organization
Organization Name:TED L EDWARDS JR MD PA
Other - Org Name:THE HILLS MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:L
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:512-327-4886
Mailing Address - Street 1:4201 BEE CAVES RD
Mailing Address - Street 2:
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-6465
Mailing Address - Country:US
Mailing Address - Phone:512-327-4886
Mailing Address - Fax:512-327-4958
Practice Address - Street 1:4201 BEE CAVES RD
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6465
Practice Address - Country:US
Practice Address - Phone:512-327-4886
Practice Address - Fax:512-327-4958
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TED L EDWARDS JR MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-06-07
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC8269207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB103937OtherMEDICARE PTAN