Basic Information
| Provider Information | |||||||||
| NPI: | 1306214903 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EDEMA PARTNERS, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1160 EASTERN PKWY STE 2313 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402171405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5023099800 | ||||||||
| FaxNumber: | 5023099797 | ||||||||
| Practice Location | |||||||||
| Address1: | 1169 EASTERN PKWY | ||||||||
| Address2: | SUITE 2313 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402171417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5023099800 | ||||||||
| FaxNumber: | 5023099797 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2015 | ||||||||
| LastUpdateDate: | 09/30/2021 | ||||||||
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| AuthorizedOfficialLastName: | EVANS | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
| AuthorizedOfficialMiddleName: | BETH | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5023099800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 001579 | KY | N | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 332BC3200X | N | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment | 225X00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 000000972249 | 01 | KY | ANTHEM BCBS | OTHER |