Provider Demographics
NPI:1871996884
Name:EDGEWOOD MEDICAL LLC
Entity type:Organization
Organization Name:EDGEWOOD MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-273-8348
Mailing Address - Street 1:7455 ARROYO CROSSING PKWY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-4085
Mailing Address - Country:US
Mailing Address - Phone:775-273-8348
Mailing Address - Fax:
Practice Address - Street 1:7455 ARROYO CROSSING PKWY
Practice Address - Street 2:SUITE 220
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-4085
Practice Address - Country:US
Practice Address - Phone:775-273-8348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies