Healthcare Provider Details

I. General information

NPI: 1245565811
Provider Name (Legal Business Name): EDGEMON & ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2009
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 13TH STREET SUITE F
ST. CLOUD FL
34769
US

IV. Provider business mailing address

2521 13TH STREET SUITE F
ST. CLOUD FL
34769
US

V. Phone/Fax

Practice location:
  • Phone: 407-891-8884
  • Fax: 407-957-7800
Mailing address:
  • Phone: 407-891-8884
  • Fax: 407-957-7800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number299992363
License Number StateFL

VIII. Authorized Official

Name: MRS. SONYA EDGEMON-SMITH
Title or Position: PRESIDENT
Credential:
Phone: 407-891-8884