Provider Demographics
NPI:1891182812
Name:EDL MEDICAL, LLC
Entity Type:Organization
Organization Name:EDL MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-794-2300
Mailing Address - Street 1:39 DAVID SWAN LN
Mailing Address - Street 2:
Mailing Address - City:PURVIS
Mailing Address - State:MS
Mailing Address - Zip Code:39475-3076
Mailing Address - Country:US
Mailing Address - Phone:601-794-2300
Mailing Address - Fax:601-794-2500
Practice Address - Street 1:39 DAVID SWAN LN
Practice Address - Street 2:
Practice Address - City:PURVIS
Practice Address - State:MS
Practice Address - Zip Code:39475-3076
Practice Address - Country:US
Practice Address - Phone:601-794-2300
Practice Address - Fax:601-794-2500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-16
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1363291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory