OrganizationActive
Edison Revolution, LLC
NPI 1346004108 · Exclusive Provider Organization · Jenks, OK
Provider details
- NPI number
- 1346004108
- Entity type
- Organization
- Primary specialty
- Exclusive Provider OrganizationManaged Care Organizations
- Organization subpart
- No
- Authorized official
- Glenn Eddleman, Member(918) 808-1802
Specialties & taxonomies
Managed Care Organizations
Practice location
100 S Riverfront Dr Ste 400
Jenks, OK 74037-5691
Phone: (800) 967-2077
Approximate (ZIP-level) locationGet directions
Mailing address
100 S Riverfront Dr Ste 400
Jenks, OK 74037-5691
Registry dates
- Enumerated
- 2024-02-12
- Last updated
- 2024-02-12
- Certified
- 2024-02-12
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.