1669167334 NPI number — DR. STEWART CAMERON EDGELL MBBS MRCGP FRACGP

Table of content: DR. STEWART CAMERON EDGELL MBBS MRCGP FRACGP (NPI 1669167334)

General
Organization/Personal Information
Provider's Other Name Information
NPI Number Information
Provider's Business Mailing Address
Provider's Practice Location Mailing Address
Additional Information
Authorized Official
Provider Taxonomy Codes
Other Provider's Identifiers (legacy, non-NPI)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669167334 NPI number — DR. STEWART CAMERON EDGELL MBBS MRCGP FRACGP

Organization/Personal Information

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:
EDGELL

Provider First Name:
STEWART

Provider Middle Name:
CAMERON

Provider Name Prefix Text:
DR.

Provider Name Suffix Text:

Provider Credential Text:
MBBS MRCGP FRACGP

Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:

Provider Other Organization Name Type Code:

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:
1669167334

Entity Type Code:
Individual

Replacement NPI:

Last Update Date:
04/10/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
127 MUGGA WAY

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:
RED HILL

Provider Business Mailing Address State Name:
AUSTRALIAN CAPITAL TERRITORY

Provider Business Mailing Address Postal Code:
ACT 2603

Provider Business Mailing Address Country Code:
AU

Provider Business Mailing Address Telephone Number:

Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HUME HEALTH CENTRE, ALEXANDER MACONOCHIE CENTRE

Provider Second Line Business Practice Location Address:
10400 MONARO HIGHWAY

Provider Business Practice Location Address City Name:
HUME

Provider Business Practice Location Address State Name:
AUSTRALIAN CAPITAL TERRITORY

Provider Business Practice Location Address Postal Code:
ACT 2620

Provider Business Practice Location Address Country Code:
AU

Provider Business Practice Location Address Telephone Number:
612-512-4224

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:
04/10/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

Provider Taxonomy Codes

Taxonomy code: 207Q00000X , with the licence number: MED0000982983 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .