Healthcare Provider Details

I. General information

NPI: 1184541369
Provider Name (Legal Business Name): EDWARD JAMES EDMONDS HT, QIHC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4555 FOREST PARK AVE APT 118
SAINT LOUIS MO
63108-2173
US

IV. Provider business mailing address

4555 FOREST PARK AVE APT 118
SAINT LOUIS MO
63108-2173
US

V. Phone/Fax

Practice location:
  • Phone: 605-212-8905
  • Fax:
Mailing address:
  • Phone: 605-212-8905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: