Healthcare Provider Details

I. General information

NPI: 1306942339
Provider Name (Legal Business Name): EDMED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8905 NW 112TH ST
OKLAHOMA CITY OK
73162-2161
US

IV. Provider business mailing address

8905 NW 112TH ST
OKLAHOMA CITY OK
73162-2161
US

V. Phone/Fax

Practice location:
  • Phone: 405-824-4304
  • Fax:
Mailing address:
  • Phone: 405-824-4304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateOK

VIII. Authorized Official

Name: EDWARD ALAN RAYLS
Title or Position: PRESIDENT
Credential: R.T.(R)
Phone: 405-812-1420