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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1588996920
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL EDGE HEALTHCARE GROUP PA

Provider Business Mailing Address
First Line	:	2800 E HIGHWAY 114 STE 200
Second Line	:
City	:	TROPHY CLUB
State	:	TX
Zip	:	76262-5306
Country	:	US
Telephone Number	:	817-837-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 E HIGHWAY 114 STE 200
Second Line	:
City	:	TROPHY CLUB
State	:	TX
Zip	:	76262-5306
Country	:	US
Telephone Number	:	817-837-3000
Fax Number	:

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

Provider Enumeration Date	:	02/10/2010
Last Update Date	:	05/03/2010

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