Basic Information
| Provider Information | |||||||||
| NPI: | 1588996920 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDICAL EDGE HEALTHCARE GROUP PA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ARLINGTON CANCER CENTER AT TROPHY CLUB | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2800 E HIGHWAY 114 STE 200 | ||||||||
| Address2: | |||||||||
| City: | TROPHY CLUB | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762625306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8178373000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2800 E HIGHWAY 114 STE 200 | ||||||||
| Address2: | |||||||||
| City: | TROPHY CLUB | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762625306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8178373000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2010 | ||||||||
| LastUpdateDate: | 05/03/2010 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HEIGHTEN | ||||||||
| AuthorizedOfficialFirstName: | CLAY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9727393001 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.