Provider Demographics
NPI:1871909275
Name:EDGEWOOD RURAL HEALTHH CLINIC
Entity type:Organization
Organization Name:EDGEWOOD RURAL HEALTHH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:RIZVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-896-2222
Mailing Address - Street 1:106 EAST PINE STREET
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:75117
Mailing Address - Country:US
Mailing Address - Phone:903-896-2222
Mailing Address - Fax:
Practice Address - Street 1:106 EAST PINE STREET
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:TX
Practice Address - Zip Code:75117
Practice Address - Country:US
Practice Address - Phone:903-896-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RITZ HOSPITALITY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty