Provider Demographics
NPI:1477892529
Name:EDGIN, JASON SCOT
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:SCOT
Last Name:EDGIN
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 1:820 N HICKORY AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-1645
Mailing Address - Country:US
Mailing Address - Phone:580-475-2974
Mailing Address - Fax:
Practice Address - Street 1:820 N HICKORY AVE
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-1645
Practice Address - Country:US
Practice Address - Phone:580-475-2974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-10
Last Update Date:2013-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator