1811921067 NPI number — CUTTING EDGE MEDICAL LLC

Table of content: (NPI 1811921067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811921067 NPI number — CUTTING EDGE MEDICAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CUTTING EDGE MEDICAL LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COUNTRY MEDICAL SUPPLY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811921067
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 249
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BONHAM
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75418-0249
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-640-0202
Provider Business Mailing Address Fax Number:
903-640-0223

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2620 N CENTER ST
Provider Second Line Business Practice Location Address:
STE 103 A
Provider Business Practice Location Address City Name:
BONHAM
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75418-2100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-640-0202
Provider Business Practice Location Address Fax Number:
903-640-0223
Provider Enumeration Date:
07/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OLIVER
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
LANE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
903-640-0202

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)