Provider Demographics
NPI:1285086397
Name:EDGE-MD HOLDING PLLC
Entity type:Organization
Organization Name:EDGE-MD HOLDING PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:PHUCKHAC
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-532-2000
Mailing Address - Street 1:1200 W. WALNUT HILL LANE
Mailing Address - Street 2:SUITE 3950
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038
Mailing Address - Country:US
Mailing Address - Phone:972-514-1672
Mailing Address - Fax:214-699-4397
Practice Address - Street 1:1200 W. WALNUT HILL LANE
Practice Address - Street 2:SUITE 3950
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038
Practice Address - Country:US
Practice Address - Phone:972-514-1672
Practice Address - Fax:214-699-4397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-13
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty