Provider Demographics
NPI:1801549670
Name:EDWOOD PROFESSIONAL SERVICES, LLC
Entity type:Organization
Organization Name:EDWOOD PROFESSIONAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:UCHENNA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ONYENOBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-590-0216
Mailing Address - Street 1:14199 N INTERSTATE 35 APT 3204
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-6432
Mailing Address - Country:US
Mailing Address - Phone:512-590-0216
Mailing Address - Fax:
Practice Address - Street 1:14199 N INTERSTATE 35 APT 3204
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-6432
Practice Address - Country:US
Practice Address - Phone:512-590-0216
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies