# MEDICAL EDGE HEALTHCARE GROUP PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639122021
- **Authorized official:** CLAY M. HEIGHTEN M.D. (PRESIDENT)
- **Authorized official phone:** (972) 739-3001

## Contact information

- **Practice address:** 9229 LYNDON B JOHNSON FWY STE 250, DALLAS, TX 75243-4403
- **Practice address phone:** (972) 739-3001
- **Mailing address:** 9229 LYNDON B JOHNSON FWY STE 250, DALLAS, TX 75243-4403
- **Mailing address phone:** (972) 739-3001

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | — | NULL | — |
| 111N00000X | Chiropractor | — | — | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | NULL | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207RC0000X | Cardiovascular Disease Physician | — | NULL | — |
| 207RC0000X | Cardiovascular Disease Physician | — | — | — |
| 207RG0300X | Geriatric Medicine (Internal Medicine) Physician | — | NULL | — |
| 207RG0300X | Geriatric Medicine (Internal Medicine) Physician | — | — | — |
| 207RH0003X | Hematology & Oncology Physician | — | NULL | — |
| 207RH0003X | Hematology & Oncology Physician | — | — | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | — |
| 207X00000X | Orthopaedic Surgery Physician | — | — | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | — |
| 2085R0202X | Diagnostic Radiology Physician | — | NULL | — |
| 2085R0202X | Diagnostic Radiology Physician | — | — | — |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | — |
| 208D00000X | General Practice Physician | — | — | — |
| 261QR0200X | Radiology Clinic/Center | — | NULL | — |
| 363AM0700X | Medical Physician Assistant | — | NULL | — |
| 363AM0700X | Medical Physician Assistant | — | — | — |

## Other

- **Enumeration date:** 05/18/2006
- **Last updated:** 09/16/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0046AZ | BCBS | TX |
| 01 | — | 00516N | BCBS | TX |
| 01 | — | 0099BH | BCBS | TX |
| 05 | — | 081500301 | — | TX |
| 05 | — | 081500302 | — | TX |
| 05 | — | 081500315 | — | TX |
| 05 | — | 081500316 | — | TX |
| 05 | — | 186985101 | — | TX |
| 05 | — | 186985102 | — | TX |
| 05 | — | 186985103 | — | TX |
| 05 | — | 200384001 | — | TX |