Provider Demographics
NPI:1386783520
Name:EDNEM MEDICAL SERVICES, PA
Entity type:Organization
Organization Name:EDNEM MEDICAL SERVICES, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EDSEL
Authorized Official - Middle Name:JERONIMO
Authorized Official - Last Name:COMENENCIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-482-2221
Mailing Address - Street 1:7148 CURRY FORD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-5803
Mailing Address - Country:US
Mailing Address - Phone:407-482-2221
Mailing Address - Fax:407-482-2284
Practice Address - Street 1:7148 CURRY FORD RD STE 100
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-5803
Practice Address - Country:US
Practice Address - Phone:407-482-2221
Practice Address - Fax:407-482-2284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266610300Medicaid
FL266610300Medicaid