MEDICARE: EDSON MEDICAL ASSOCIATES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1073890588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDSON MEDICAL ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	2845 CAPITAL AVE SW STE 202
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49015-4186
Country	:	US
Telephone Number	:	801-243-7082
Fax Number	:

Provider Business Practice Location Address
First Line	:	2845 CAPITAL AVE SW STE 202
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49015-4186
Country	:	US
Telephone Number	:	269-223-7045
Fax Number	:	269-282-0758

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ALLAN C EDSON
Credential	:	DO
Telephone Number	:	801-243-7082

Provider Enumeration Date	:	11/11/2011
Last Update Date	:	03/22/2019

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Directions to “EDSON MEDICAL ASSOCIATES LLC ” Practice Location

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