Provider Demographics
NPI:1972822914
Name:MEDICAL EDGE HEALTHCARE GROUP P A
Entity Type:Organization
Organization Name:MEDICAL EDGE HEALTHCARE GROUP P A
Other - Org Name:ARLINGTON CANCER CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLAY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEIGHTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-739-3001
Mailing Address - Street 1:906 W RANDOL MILL RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-2510
Mailing Address - Country:US
Mailing Address - Phone:817-543-4685
Mailing Address - Fax:817-543-4643
Practice Address - Street 1:906 W RANDOL MILL RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-2510
Practice Address - Country:US
Practice Address - Phone:817-543-4685
Practice Address - Fax:817-543-4643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX269233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5900255OtherNCPDP PROVIDER IDENTIFICATION NUMBER
5900255OtherNCPDP PROVIDER IDENTIFICATION NUMBER