Healthcare Provider Details

I. General information

NPI: 1801662135
Provider Name (Legal Business Name): EDWARDS MEDICAL PROVIDER GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 WALNUT ST STE 104B
BOULDER CO
80302-5399
US

IV. Provider business mailing address

2205 CORDILLERA WAY
EDWARDS CO
81632-6290
US

V. Phone/Fax

Practice location:
  • Phone: 970-693-0015
  • Fax:
Mailing address:
  • Phone: 737-247-1223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY BLAIR ELDER
Title or Position: REVENUE CYCLE ADMINISTRATOR
Credential: PHD
Phone: 737-247-1223