MEDICARE: MEDICAL EDGE HEALTHCARE GROUP PA

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	261QX0203X	Radiation Oncology Clinic/Center	R31452	TX

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	:	1265470660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL EDGE HEALTHCARE GROUP PA

Provider Business Mailing Address
First Line	:	PO BOX 650268
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75265-0268
Country	:	US
Telephone Number	:	888-238-9671
Fax Number	:

Provider Business Practice Location Address
First Line	:	6957 W PLANO PKWY STE 1300
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75093-1621
Country	:	US
Telephone Number	:	972-820-1400
Fax Number	:	214-820-1020

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CLAY HEIGHTEN
Credential	:	M.D.
Telephone Number	:	972-739-3001

Provider Enumeration Date	:	06/04/2006
Last Update Date	:	09/29/2011

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