Healthcare Provider Details

I. General information

NPI: 1922248848
Provider Name (Legal Business Name): EDGEWOOD PROFESSIONAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2009
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 EDGEWOOD DRIVE EXT
TRANSFER PA
16154-1817
US

IV. Provider business mailing address

239 EDGEWOOD DRIVE EXT
TRANSFER PA
16154-1817
US

V. Phone/Fax

Practice location:
  • Phone: 724-646-7246
  • Fax: 724-646-0413
Mailing address:
  • Phone: 800-223-5544
  • Fax: 724-294-3206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: KURTIS GRAMLEY
Title or Position: CHAIRMAN
Credential:
Phone: 724-646-0400