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General NPI Number Information
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NPI Number | 1417328709
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Entity Type | Organization
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Legal Business Name | EDGE MEDICAL MARKETING LLC
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Dates
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Enumeration Date | 10/12/2015
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Last Update Date | 10/12/2015
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Provider Practice Location Address
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Address Line | 6586 HYPOLUXO RD STE 264
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City | LAKE WORTH
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State | FL
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Zip | 33467-7678
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Country | US
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Telephone | 954-418-2613
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Fax | 561-828-3372
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Provider Business Mailing Address
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Address Line | 6586 HYPOLUXO RD STE 264
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City | LAKE WORTH
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State | FL
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Zip | 33467-7678
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Country | US
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Telephone | 954-418-2613
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Fax | 561-828-3372
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARY C MARTINEZ
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Credential |
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Telephone | 954-418-2613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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