Basic Information
| Provider Information | |||||||||
| NPI: | 1528552734 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EDGE MEDICAL CONSULTING LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 231 LUCERNE BLVD | ||||||||
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| City: | HOMEWOOD | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352096613 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2055872974 | ||||||||
| FaxNumber: | 2058741606 | ||||||||
| Practice Location | |||||||||
| Address1: | 3800 RIDGEWAY DR | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352095506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2058682000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2018 | ||||||||
| LastUpdateDate: | 06/20/2018 | ||||||||
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| AuthorizedOfficialLastName: | EDGE | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLEY | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 2055872974 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.