| Edgewater Internal Medicine Assoc. Inc. | |
|
2568 S. Ridgewood Ave Suite 5 Edgewater FL 32141-7535 | |
| (386) 428-4640 | |
| (386) 426-1409 |
| Full Name | Edgewater Internal Medicine Assoc. Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 2568 S. Ridgewood Ave, Edgewater, Florida |
| Authorized Official Name and Position | Leslie Manuel Lee (PRESIDENT OWNER) |
| Authorized Official Contact | 3864284640 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Edgewater Internal Medicine Assoc. Inc. 2568 South Ridgewood Ave Suite 5 Edgewater FL 32111-7535 Ph: (386) 428-4640 | Edgewater Internal Medicine Assoc. Inc. 2568 S. Ridgewood Ave Suite 5 Edgewater FL 32141-7535 Ph: (386) 428-4640 |
| NPI Number | 1518938372 |
|---|---|
| Provider Enumeration Date | 01/30/2006 |
| Last Update Date | 08/04/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518938372 | NPI | - | NPPES |
| 23541 | Other | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | ME0063341 (Florida) | Primary |
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