MEDICARE: EDGE MEDICAL SERVICES

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	261QB0400X	Birthing Clinic/Center

General Provider Information

NPI Number	:	1568909372
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDGE MEDICAL SERVICES

Provider Business Mailing Address
First Line	:	1141 N LOOP 11604 E, 105187
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-1339
Country	:	US
Telephone Number	:	800-348-4623
Fax Number	:

Provider Business Practice Location Address
First Line	:	5107 S 900 E STE 140
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-6630
Country	:	US
Telephone Number	:	800-348-4623
Fax Number	:

Authorized Official
Title or Position	:	ADMIN
Name	:	KELLY GARRETT
Credential	:
Telephone Number	:	800-348-4623

Provider Enumeration Date	:	01/31/2017
Last Update Date	:	04/15/2020

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Directions to “EDGE MEDICAL SERVICES ” Practice Location

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