MEDICARE: STEVEN A EDMONDSON MD

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	C4929	AR

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831186816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN A EDMONDSON MD

Provider Business Mailing Address
First Line	:	12 E APPLEBY
Second Line	:	CLINIC ADMINISTRATION
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703
Country	:	US
Telephone Number	:	479-463-1704
Fax Number	:	479-463-7864

Provider Business Practice Location Address
First Line	:	3215 N NORTH HILLS BLVD
Second Line	:	HOSPITAL MEDICINE GROUP
City	:	FAYETTEVILLE
State	:	AR
Zip	:	72703
Country	:	US
Telephone Number	:	479-463-1000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	09/22/2009

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Directions to “ STEVEN A EDMONDSON MD” Practice Location

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