Healthcare Provider Details

I. General information

NPI: 1366246118
Provider Name (Legal Business Name): EDGE MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 TRAIL VIEW LN SE
PINE ISLAND MN
55963-8608
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: 888-329-2091
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ERIKA LEWIS
Title or Position: CFO
Credential:
Phone: 800-341-8598