MEDICARE: STACY EDWARDS, INC

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	207R00000X	Internal Medicine Physician	OS7714	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	257297	OTHER	FL	AVMED
2	5580758	OTHER	FL	AETNA
3	123421	OTHER	FL	HUMANA
4	20886	OTHER	FL	BCBS
5	0161979008	OTHER	FL	CIGNA
6	1057441	OTHER	FL	AETNA
7	1320	OTHER	FL	BAYCARE
8	0001713	OTHER	FL	UHC
9	0412595	OTHER	FL	UHC

General Provider Information

NPI Number	:	1730105172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STACY EDWARDS, INC

Provider Business Mailing Address
First Line	:	1022 MAIN ST
Second Line	:	SUITE M
City	:	DUNEDIN
State	:	FL
Zip	:	34698-5225
Country	:	US
Telephone Number	:	727-733-7922
Fax Number	:	737-738-6205

Provider Business Practice Location Address
First Line	:	2623 MCCORMICK DR STE 101
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33759-1046
Country	:	US
Telephone Number	:	727-564-9336
Fax Number	:	727-223-3228

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. STACY L EDWARDS
Credential	:	DO
Telephone Number	:	727-410-6655

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	10/29/2024

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Directions to “STACY EDWARDS, INC ” Practice Location

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