Thomas G Edwards, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

10000133 Issued in IN

Practice address

2200 Randallia Dr
Fort Wayne, IN 46805-4638

Phone

(260) 373-4000

Fax

(260) 482-4442

NPI assigned

Nov 22, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1132617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1384300800000",
    "number": "1023091253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3640 NEW VISION DRIVE",
            "address_2": "SUITE A",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451717",
            "telephone_number": "260-482-4440",
            "fax_number": "260-482-4442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 RANDALLIA DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468054638",
            "telephone_number": "260-373-4000",
            "fax_number": "260-482-4442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "THOMAS",
        "middle_name": "G",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-22",
        "last_updated": "2013-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IN",
            "license": "10000133",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Edt, Inc.
• Debra E Edwards, OTR
• Joseph A. Vincent Edwards, NP
• Lakyn Edwards
• Shelly J Edwards, LMFT
• Joseph W Egbert, CRNA
• Susan Lynn Eggebrecht, OD
• Zachary Alan Eggebrecht, MD
• Janet M. Eggiman, LMFT
• Madison Eghigian

• Medical Physician Assistant in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Medical Physician Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.