MEDICARE: CYNTHIA EDWARDS

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1437555075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA EDWARDS

Provider Business Mailing Address
First Line	:	3921 FOX RUN DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-2511
Country	:	US
Telephone Number	:	409-392-7153
Fax Number	:	817-294-4357

Provider Business Practice Location Address
First Line	:	3921 FOX RUN DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-2511
Country	:	US
Telephone Number	:	409-392-7153
Fax Number	:	817-294-4357

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2014
Last Update Date	:	11/10/2014

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