1629144688 NPI number — MEDICAL EDGE HEALTHCARE GROUP PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629144688 NPI number — MEDICAL EDGE HEALTHCARE GROUP PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL EDGE HEALTHCARE GROUP PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SLEEP HEALERS OF COPPELL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629144688
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9229 LYNDON B JOHNSON FWY
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75243-3405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-739-3097
Provider Business Mailing Address Fax Number:
972-739-2673

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
546 E SANDY LAKE RD
Provider Second Line Business Practice Location Address:
SUITE 210A
Provider Business Practice Location Address City Name:
COPPELL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75019-5786
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-506-7800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HEIGHTEN
Authorized Official First Name:
CLAY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
972-739-3001

Provider Taxonomy Codes

  • Taxonomy code: 261QS1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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