Healthcare Provider Details

I. General information

NPI: 1831404615
Provider Name (Legal Business Name): MEDICAL EDGE HEALTHCARE GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2010
Last Update Date: 08/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 SW WILSHIRE BLVD
BURLESON TX
76028-8338
US

IV. Provider business mailing address

2730 SW WILSHIRE BLVD
BURLESON TX
76028-8338
US

V. Phone/Fax

Practice location:
  • Phone: 817-916-5180
  • Fax: 817-916-5199
Mailing address:
  • Phone: 817-916-5180
  • Fax: 817-916-5199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: CLAY M HEIGHTEN
Title or Position: PRESIDENT
Credential: MD
Phone: 972-739-3001