Organization
EDISON REVOLUTION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLENN EDDLEMAN (MEMBER)
(918) 808-1802
Entity
Organization
Contact information
Practice address
100 S RIVERFRONT DR STE 400, JENKS, OK 74037-5691
(800) 967-2077
Mailing address
100 S RIVERFRONT DR STE 400, JENKS, OK 74037-5691
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
—
Other
Enumeration date
02/12/2024
Last updated
02/12/2024
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