=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932325222
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EDARCH MEDICAL INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3801 CORPOREX PARK DR STE. 175
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33619-1183
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-626-1333
-----------------------------------------------------
Fax | 813-622-6662
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3801 CORPOREX PARK DR STE. 175
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33619-1183
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-626-1333
-----------------------------------------------------
Fax | 813-622-6662
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. KEITH EDWARDS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 813-626-1333
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 1312356
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------