Provider Demographics
NPI:1295970952
Name:PATRICK J EDWARDS MD PA
Entity type:Organization
Organization Name:PATRICK J EDWARDS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-998-5501
Mailing Address - Street 1:PO BOX 1480
Mailing Address - Street 2:2600 LOCKWOOD SUITE C
Mailing Address - City:TAHOKA
Mailing Address - State:TX
Mailing Address - Zip Code:79373-1480
Mailing Address - Country:US
Mailing Address - Phone:806-998-5501
Mailing Address - Fax:806-561-5504
Practice Address - Street 1:2600 LOCKWOOD
Practice Address - Street 2:SUITE C
Practice Address - City:TAHOKA
Practice Address - State:TX
Practice Address - Zip Code:79373
Practice Address - Country:US
Practice Address - Phone:806-998-5501
Practice Address - Fax:806-561-5504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207Q00000X207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
201884802OtherTEXAS MEDICAID TEXAS HEALTH STEPS
TX135749312Medicaid
TX201884801Medicaid
TX0A3326Medicare PIN