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General NPI Number Information
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NPI Number | 1114096138
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Entity Type | Organization
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Legal Business Name | CAROL E. EDWARDS
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 10/06/2010
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Provider Practice Location Address
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Address Line | 1423 N MAIN ST
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City | CLOVIS
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State | NM
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Zip | 88101-4747
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Country | US
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Telephone | 575-935-4357
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Fax | 575-935-4358
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Provider Business Mailing Address
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Address Line | 1423 N MAIN ST
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City | CLOVIS
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State | NM
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Zip | 88101-4747
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Country | US
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Telephone | 575-935-4357
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Fax | 575-935-4358
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Authorized Official
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Title or Position | OWNER
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Name | MS. CAROL ELIZABETH EDWARDS
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Credential |
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Telephone | 505-935-4357
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State | NM
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