Provider Demographics
NPI:1740280486
Name:MRC EDGEWATER
Entity type:Organization
Organization Name:MRC EDGEWATER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:BERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-363-2600
Mailing Address - Street 1:2228 SEAWALL BLVD
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77550-8940
Mailing Address - Country:US
Mailing Address - Phone:409-763-6437
Mailing Address - Fax:409-765-6551
Practice Address - Street 1:2228 SEAWALL BLVD
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-8940
Practice Address - Country:US
Practice Address - Phone:409-763-6437
Practice Address - Fax:409-765-6551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX808305251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX675941Medicare ID - Type Unspecified