MEDICARE: EDGE MEDICAL MARKETING LLC

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	302F00000X	Exclusive Provider Organization

General Provider Information

NPI Number	:	1417328709
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDGE MEDICAL MARKETING LLC

Provider Business Mailing Address
First Line	:	6586 HYPOLUXO RD
Second Line	:	STE 264
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-7678
Country	:	US
Telephone Number	:	954-418-2613
Fax Number	:	561-828-3372

Provider Business Practice Location Address
First Line	:	6586 HYPOLUXO RD
Second Line	:	STE 264
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-7678
Country	:	US
Telephone Number	:	954-418-2613
Fax Number	:	561-828-3372

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARY C MARTINEZ
Credential	:
Telephone Number	:	954-418-2613

Provider Enumeration Date	:	10/12/2015
Last Update Date	:	10/12/2015

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