Provider Demographics
NPI:1649710344
Name:EDGE MEDICAL SERVICES
Entity type:Organization
Organization Name:EDGE MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:2107-878-3440
Mailing Address - Street 1:1411 N LOOP 1604 E
Mailing Address - Street 2:105187
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1339
Mailing Address - Country:US
Mailing Address - Phone:210-787-8344
Mailing Address - Fax:
Practice Address - Street 1:12330 TANTALLON CT
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28134-6410
Practice Address - Country:US
Practice Address - Phone:210-787-8344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EDGE MEDICAL SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-28
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QB0400XAmbulatory Health Care FacilitiesClinic/CenterBirthing