Edge Sports Performance

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

EDGE SPORTS PERFORMANCE

Practice address

3710 Tom Andrews Rd NW
Roanoke, VA 24019-3062

Phone

(540) 265-8585

NPI assigned

Aug 3, 2011

Organization subpart

No

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

Authorized official

Name

Adam Williams

Title

General Manager

Phone

(540) 265-8585

Specialties & licenses 1

Addresses

Tax ID family

Edge Sports Performance2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Player Prospect, LLC

  • Multi-Specialty Clinic/Center
  • Roanoke, VA
  • NPI 1659645943
  NPD tax ID

Locations

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

{
    "created_epoch": "1312329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312329600000",
    "number": "1982982237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 819020",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753819020",
            "telephone_number": "972-687-1877"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3710 TOM ANDREWS RD NW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240193062",
            "telephone_number": "540-265-8585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGE SPORTS PERFORMANCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-03",
        "last_updated": "2011-08-03",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "ADAM",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "540-265-8585"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard Russell Eckert, M.D.
• Sherry P. Eckert, MSN
• Kristin Lynn Eckland, ACNP, BC, RNFA
• Joseph Buckner Eddins III, PA
• Godwin Uchenna Edeh, M.D.
• Javon Miguel Edgecombe, MD
• Andrew D Edwards, LPC
• Erwood Glenn Edwards Jr., M.D.
• Keely Edwards
• Lileann Josephine Edwards

• Multi-Specialty Clinic/Center in Roanoke, VA
• Providers in Roanoke, VA by specialty
• Multi-Specialty Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2011; 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.