Individual provider Active NPI

Colby Lee Edwards, D.O.

  • Emergency Medicine Physician
  • Oklahoma City, OK
National Provider Identifier
1114093655
Registry record updated Oct 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
4400 Issued in OK
Practice address
4200 S Douglas Ave Ste 306
Ismc Emergency Medicine
Oklahoma City, OK 73109-3215
Phone
(405) 636-7195
NPI assigned
Nov 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 4400 OK Primary

Addresses

Primary practice location

4200 S Douglas Ave Ste 306
Ismc Emergency Medicine
Oklahoma City, OK 73109-3215

Mailing address

1212 Mary Lee LN
Edmond, OK 73034-5427
Phone (405) 471-6112

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111118000350 OK Practitioner - Emergency Medicine 6305010802 Reassigns benefits to 4 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
4400OKMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Physicians of Mid-America, P.C. Emergency Medicine CurrentSince Dec 1, 2014 Accepting new patients
Mercy Clinic Oklahoma Communities CurrentSince Apr 1, 2019 Accepting new patients
Emergency Services of Oklahoma PC Emergency Medicine CurrentSince Dec 5, 2017 Accepting new patients
Oklahoma Emergency Services PC Emergency Medicine CurrentSince Aug 1, 2013 Accepting new patients
Mercy Hospital Oklahoma City, Inc Past Accepting new patients

Locations

200 S Academy Rd
Guthrie, OK 73044
Phone (405) 260-4165

4300 McAuley Blvd
Oklahoma City, OK 73120
Phone (405) 936-5455

4300 W Memorial Rd
Oklahoma City, OK 73120
Phone (405) 752-3962

4050 W Memorial Rd
Oklahoma City, OK 73120
Phone (405) 608-3200

9600 Broadway Ext
Oklahoma City, OK 73114
Phone (405) 486-2100

1500 N Green Ave
Purcell, OK 73080
Phone (405) 527-2250

1102 W MacArthur St
Shawnee, OK 74804
Phone (405) 273-2270

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350345600000",
    "number": "1114093655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1212 MARY LEE LN",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "730345427",
            "telephone_number": "405-471-6112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 S DOUGLAS AVE STE 306",
            "address_2": "ISMC EMERGENCY MEDICINE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731093215",
            "telephone_number": "405-636-7195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "COLBY",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-27",
        "last_updated": "2012-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OK",
            "license": "4400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.