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General NPI Number Information
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NPI Number | 1699797142
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Entity Type | Organization
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Legal Business Name | MEDICAL EDGE HEALTHCARE GROUP PA
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 07/11/2008
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Provider Practice Location Address
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Address Line | 1645 N TOWN EAST BLVD STE 503
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City | MESQUITE
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State | TX
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Zip | 75150-4147
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Country | US
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Telephone | 972-686-3901
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Fax | 972-686-3985
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Provider Business Mailing Address
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Address Line | 1645 N TOWN EAST BLVD STE 503
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City | MESQUITE
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State | TX
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Zip | 75150-4147
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Country | US
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Telephone | 972-686-3901
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Fax | 972-686-3985
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Authorized Official
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Title or Position | PRESIDENT
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Name | CLAY HEIGHTEN
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Credential | MD
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Telephone | 972-739-3001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number |
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License Number State |
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