Provider Demographics
NPI:1427711829
Name:EDWARDS MEDICAL PROVIDER GROUP
Entity type:Organization
Organization Name:EDWARDS MEDICAL PROVIDER GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-926-5846
Mailing Address - Street 1:2205 CORDILLERA WAY
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-6290
Mailing Address - Country:US
Mailing Address - Phone:800-478-0233
Mailing Address - Fax:
Practice Address - Street 1:11951 E ILIFF AVE STE B
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-4925
Practice Address - Country:US
Practice Address - Phone:855-235-9792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-21
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty