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General NPI Number Information
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NPI Number | 1851721930
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Entity Type | Organization
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Legal Business Name | IEME
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Dates
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Enumeration Date | 11/26/2013
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Last Update Date | 11/26/2013
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Provider Practice Location Address
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Address Line | 20079 STONE OAK PKWY STE 1200
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City | SAN ANTONIO
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State | TX
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Zip | 78258-6942
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Country | US
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Telephone | 210-370-9712
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Fax | 210-370-9717
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Provider Business Mailing Address
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Address Line | 18866 STONE OAK PKWY SUITE 103-117
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4180
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | IVAN EDWARDS
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Credential | DO
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Telephone | 210-370-9712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | N6275
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License Number State | TX
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