Healthcare Provider Details

I. General information

NPI: 1568909372
Provider Name (Legal Business Name): EDGE MEDICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5107 S 900 E STE 140
SALT LAKE CITY UT
84117-6630
US

IV. Provider business mailing address

1141 N LOOP 11604 E, 105187
SAN ANTONIO TX
78232-1339
US

V. Phone/Fax

Practice location:
  • Phone: 800-348-4623
  • Fax:
Mailing address:
  • Phone: 800-348-4623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KELLY GARRETT
Title or Position: ADMIN
Credential:
Phone: 800-348-4623