MEDICARE: JOHN H EDMUNDS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0011X	Interventional Cardiology Physician	9500065	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184724338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN H EDMUNDS M.D.

Provider Business Mailing Address
First Line	:	321 MULBERRY ST SW
Second Line	:	MEDICAL STAFF SERVICES
City	:	LENOIR
State	:	NC
Zip	:	28645-5720
Country	:	US
Telephone Number	:	828-757-5965
Fax Number	:	828-757-5104

Provider Business Practice Location Address
First Line	:	322 MULBERRY STREET, SW
Second Line	:	SUITE F
City	:	LENOIR
State	:	NC
Zip	:	28645-5703
Country	:	US
Telephone Number	:	828-757-6462
Fax Number	:	828-757-6490

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	12/29/2016

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