NPIMap

Organization Active NPI

Edwards Clinic, PSC

  • Rural Health Clinic/Center
  • Manchester, KY
National Provider Identifier
1154635407
Registry record updated Apr 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
EDWARDS CLINIC, PSC
Practice address
204 Town Branch Road
Manchester, KY 40962-1322
Phone
(606) 598-8766
Fax
(606) 598-1903
NPI assigned
Jul 28, 2010
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Dr. Dana Edwards, MDNPI 1164424131
Title
President
Phone
(606) 598-8766

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D0983576Edwards Clinic204 Town Branch Road, Manchester, KY 40962Certificate of waiverNov 8, 2026

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110415000026 KY Part B Supplier - Clinic/Group Practice 9436333465 Receives reassigned benefits from 3 practitioners
Practice locations: Corbin, KY; Hyden, KY; Manchester, KY; Pineville, KY
O20230418000725 KY Part a Provider - Rural Health Clinic 9436333465 Practice locations: Manchester, KY

Rural health clinic certification: CCN B03968

Medicare enrollment files
Legal name
EDWARDS CLINIC PSC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 28, 2025
Last certification
Jan 28, 2025
Ownership / control type
1A
Organization structure
CorporationProprietary
Incorporated
Dec 1, 1998 in KY
Enrollment address
204 Town Branch Rd
Manchester, KY 40962-1322

All disclosed owners & managing parties 1

Medicare enrollment files

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Dana P Edwards Individual 5% Or Greater Direct Ownership InterestOwner Dec 1, 1998 100%
Corporate OfficerPresident Dec 1, 1998
Operational/Managerial ControlPresident Dec 1, 1998

National Provider Directory

National Provider Directory

Locations

2886 Ky 1629
Corbin, KY 40701
Phone (606) 598-8766

204 Town Branch Rd
#1
Manchester, KY 40962

Specialties & licenses 4

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X KY
Rural Health Clinic/Center 261QR1300X Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X KY
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X KY

Addresses

NPPES NPI Registry

Primary practice location

204 Town Branch Road
Manchester, KY 40962-1322

Mailing address

204 Town Branch Rd
Manchester, KY 40962-1322
Phone (606) 598-8766

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
7100157720MedicaidKY

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 22, 2025.

{
    "created_epoch": "1280275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745280000000",
    "number": "1154635407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 TOWN BRANCH RD",
            "city": "MANCHESTER",
            "state": "KY",
            "postal_code": "409621322",
            "telephone_number": "606-598-8766",
            "fax_number": "606-598-1903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 TOWN BRANCH ROAD",
            "city": "MANCHESTER",
            "state": "KY",
            "postal_code": "409621322",
            "telephone_number": "606-598-8766",
            "fax_number": "606-598-1903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWARDS CLINIC, PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-28",
        "last_updated": "2025-04-22",
        "certification_date": "2025-04-22",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "DANA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "606-598-8766",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "KY",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "KY",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100157720",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, KY

Sources for this page

Verify at the official NPI Registry.