Healthcare Provider Details

I. General information

NPI: 1831964402
Provider Name (Legal Business Name): EDGE MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2023
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date: 02/03/2024
Reactivation Date: 05/19/2025

III. Provider practice location address

6245 VANCE RD STE A
CHATTANOOGA TN
37421-0307
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: 800-348-4623
Mailing address:
  • Phone: 800-348-4623
  • Fax: 800-348-4623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NORA HERNANDEZ
Title or Position: OFFICE STAFF
Credential:
Phone: 800-348-4623