Provider Demographics
NPI:1912345331
Name:EDGE SPINE & JOINT MEDICAL CENTER
Entity Type:Organization
Organization Name:EDGE SPINE & JOINT MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:EDGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-837-2112
Mailing Address - Street 1:1075 S MAIN ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-4870
Mailing Address - Country:US
Mailing Address - Phone:724-837-2112
Mailing Address - Fax:724-691-0864
Practice Address - Street 1:1075 S MAIN ST
Practice Address - Street 2:SUITE 102
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601
Practice Address - Country:US
Practice Address - Phone:724-837-2112
Practice Address - Fax:724-691-0864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-07
Last Update Date:2023-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X, 208100000X
PASP011376363L00000X
PASP013678208100000X
PAMD039571L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty