MEDICARE: EDGE MEDICAL SERVICES

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	261QB0400X	Birthing Clinic/Center

General Provider Information

NPI Number	:	1255882619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDGE MEDICAL SERVICES

Provider Business Mailing Address
First Line	:	1141 N LOOP 1604 E # 105187
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-1339
Country	:	US
Telephone Number	:	800-348-4623
Fax Number	:	800-391-4146

Provider Business Practice Location Address
First Line	:	7120 SILVER PONDS HTS
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80908-4765
Country	:	US
Telephone Number	:	800-348-4623
Fax Number	:

Authorized Official
Title or Position	:	ADMIN
Name	:	VICTORIA LEE
Credential	:
Telephone Number	:	800-348-4623

Provider Enumeration Date	:	10/20/2016
Last Update Date	:	04/15/2020

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Directions to “EDGE MEDICAL SERVICES ” Practice Location

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