NPI 1346004108

Edison Revolution, LLC

Organisation Exclusive Provider Organization Jenks, OK

Practice location

Address: 100 S Riverfront Dr STE 400, Jenks, OK 74037-5691
Phone: (800) 967-2077

Authorised official

Name: Glenn Eddleman
Title: Member
Phone: (918) 808-1802

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X

Other Exclusive Provider Organization providers in Oklahoma →

Registry record

NPI: 1346004108
Entity type: Organization
NPI issued: 12 Feb 2024
Record last updated: 12 Feb 2024

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.