Provider Demographics
NPI:1831089093
Name:EDGE CONSULTING LABS
Entity type:Organization
Organization Name:EDGE CONSULTING LABS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TYKIE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:PAXTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-500-2061
Mailing Address - Street 1:3120 SOUTHWEST FWY STE 101
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-4520
Mailing Address - Country:US
Mailing Address - Phone:858-500-2061
Mailing Address - Fax:
Practice Address - Street 1:2409 BERING DR APT 25
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-4931
Practice Address - Country:US
Practice Address - Phone:858-500-2061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-08
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)