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NPI Code Detail

MEDICARE: MEDICAL EDGE HEALTHCARE GROUP PA

MEDICARE: MEDICAL EDGE HEALTHCARE GROUP PA
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
1261QR0200XRadiology Clinic/CenterR24447TX

General Provider Information

NPI Number : 1962522722
Entity Type Code : Organization
Provider Name (Legal Business Name) : MEDICAL EDGE HEALTHCARE GROUP PA
Provider Business Mailing Address
First Line : 4400 OAK PARK LN
Second Line :
City : FORT WORTH
State : TX
Zip : 76109-9534
Country : US
Telephone Number : 817-207-9600
Fax Number :
Provider Business Practice Location Address
First Line : 4400 OAK PARK LN
Second Line :
City : FORT WORTH
State : TX
Zip : 76109-9534
Country : US
Telephone Number : 817-207-9600
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : CLAY HEIGHTEN
Credential : MD
Telephone Number : 972-739-3001
Provider Enumeration Date : 03/29/2007
Last Update Date : 10/09/2008

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Directions to “MEDICAL EDGE HEALTHCARE GROUP PA ” Practice Location

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