Organization
EDEMA PARTNERS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY BETH EVANS (CEO)
(502) 309-9800
Entity
Organization
Contact information
Practice address
1169 EASTERN PKWY, SUITE 2313, LOUISVILLE, KY 40217-1417
(502) 309-9800
(502) 309-9797
Mailing address
1160 EASTERN PKWY STE 2313, LOUISVILLE, KY 40217-1405
(502) 309-9800
(502) 309-9797
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
261QP2000X
Physical Therapy Clinic/Center
001579
KY
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BC3200X
Customized Equipment (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000972249
ANTHEM BCBS
KY
Enumeration date
09/13/2015
Last updated
09/30/2021
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