Provider Demographics
NPI:1316361553
Name:CUTTING EDGE SURGICAL
Entity Type:Organization
Organization Name:CUTTING EDGE SURGICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:D
Authorized Official - Last Name:SKORUPPA
Authorized Official - Suffix:
Authorized Official - Credentials:LSA
Authorized Official - Phone:361-876-6689
Mailing Address - Street 1:5929 BRIGHTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-3029
Mailing Address - Country:US
Mailing Address - Phone:361-876-6689
Mailing Address - Fax:
Practice Address - Street 1:5929 BRIGHTWOOD DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-3029
Practice Address - Country:US
Practice Address - Phone:361-876-6689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00374363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty