Provider Demographics
NPI:1558094854
Name:CUTTING EDGE MEDICINE LLC
Entity Type:Organization
Organization Name:CUTTING EDGE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REMMINGTON
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:MBAHC
Authorized Official - Phone:907-982-7488
Mailing Address - Street 1:883 S 1540 E
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-6743
Mailing Address - Country:US
Mailing Address - Phone:907-982-7488
Mailing Address - Fax:
Practice Address - Street 1:883 S 1540 E
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-6743
Practice Address - Country:US
Practice Address - Phone:907-982-7488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty