Healthcare Provider Details

I. General information

NPI: 1851818934
Provider Name (Legal Business Name): EDGE MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2017
Last Update Date: 12/22/2024
Certification Date: 12/22/2024
Deactivation Date: 02/03/2024
Reactivation Date: 07/25/2024

III. Provider practice location address

6940 DESTINY DR
ROCKLIN CA
95677-2987
US

IV. Provider business mailing address

1141 N LOOP 1604 E # 105187
SAN ANTONIO TX
78232-1339
US

V. Phone/Fax

Practice location:
  • Phone: 800-348-4623
  • Fax:
Mailing address:
  • Phone: 800-348-4623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: FAITH BLEVINS
Title or Position: ACCOUNT MANAGER
Credential:
Phone: 800-348-4623