Basic Information
| Provider Information | |||||||||
| NPI: | 1568470524 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICAL EDGE HEALTHCARE GROUP PA | ||||||||
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| OtherOrganizationName: | PRESTONWOOD IMAGING CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6957 W PLANO PKWY STE 1100 | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750931621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723957533 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6957 W PLANO PKWY STE 1100 | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750931621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9723957533 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2006 | ||||||||
| LastUpdateDate: | 05/09/2008 | ||||||||
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| AuthorizedOfficialLastName: | HEIGHTEN | ||||||||
| AuthorizedOfficialFirstName: | CLAY | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9727393001 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR0206X | Y | Ambulatory Health Care Facilities | Clinic/Center | Radiology, Mammography |
No ID Information.