Edge-MD Rosedale, PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

N0318 Issued in TX

Legal business name

EDGE-MD ROSEDALE, PLLC

Practice address

3620 E Rosedale St
Fort Worth, TX 76105-2449

Phone

(817) 531-7000

Fax

(817) 535-3405

NPI assigned

Nov 6, 2014

Last updated

Jan 13, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Nathan P Nguyen, MDNPI 1821256942

Title

MD/Owner

Phone

(979) 532-2000

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nathan Phuckhac Nguyen, M.D,

  • Family Medicine Physician
  • Wharton, TX
  • NPI 1821256942
  Authorized official Same address or phone

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

{
    "created_epoch": "1415232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421107200000",
    "number": "1861898611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2022 REGIONAL MEDICAL DR",
            "address_2": "SUITE 1315",
            "city": "WHARTON",
            "state": "TX",
            "postal_code": "774887231",
            "telephone_number": "979-532-2000",
            "fax_number": "979-532-2008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3620 E ROSEDALE ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761052449",
            "telephone_number": "817-531-7000",
            "fax_number": "817-535-3405"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGE-MD ROSEDALE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-06",
        "last_updated": "2015-01-13",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "NATHAN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "MD/OWNER",
        "authorized_official_telephone_number": "979-532-2000",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "N0318",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eden Rejuvenation Center for Wellbeing PLLC
• Kimberly T Eden, MD
• Donna Edeza Pipes, PT
• Edge-MD McCart, PLLC
• Edge-MD Meadowbrook, PLLC
• Edgecliff Village EMS (Town of Edgecliff Village EMS)
• Patience Ediale
• Carol Diane Edley, MS CCC SLP
• Karoline Monet Edmonds, APRN, CRNA
• Steven Ray Edmondson, MD

• Family Medicine Physician in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2015; 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.