=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134493349
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HARVEY L. EDMONDS, M.D. INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/06/2012
-----------------------------------------------------
Last Update Date | 03/06/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 728 E BALLARD AVENUE SUITE 104
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-436-9800
-----------------------------------------------------
Fax | 559-436-9804
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 728 E BALLARD AVENUE SUITE 104
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-436-9800
-----------------------------------------------------
Fax | 559-436-9804
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | HARVEY LAWRENCE EDMONDS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 559-436-9800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | G24725
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------