Provider Demographics
NPI:1649891169
Name:EDISON BIO LLC
Entity type:Organization
Organization Name:EDISON BIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:MCDONOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:BBA, MBA
Authorized Official - Phone:832-691-7277
Mailing Address - Street 1:2411 WASHINGTON AVE APT 455
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-6330
Mailing Address - Country:US
Mailing Address - Phone:832-691-7277
Mailing Address - Fax:
Practice Address - Street 1:2700 POST OAK BLVD,
Practice Address - Street 2:GALLERIA OFFICE TOWER I
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056
Practice Address - Country:US
Practice Address - Phone:832-691-7277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Multi-Specialty