Healthcare Provider Details

I. General information

NPI: 1275452054
Provider Name (Legal Business Name): EDGE PINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 W TROY ST STE B
DOTHAN AL
36303-4455
US

IV. Provider business mailing address

1111 N WESTERN AVE UNIT 1N
CHICAGO IL
60622-5956
US

V. Phone/Fax

Practice location:
  • Phone: 773-562-0210
  • Fax:
Mailing address:
  • Phone: 773-562-0210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ZOYA ALI
Title or Position: MANAGER
Credential:
Phone: 773-562-0210