Provider Demographics
NPI:1598384497
Name:CUTTING EDGE ORTHOPEDIC & SPINE LLC
Entity Type:Organization
Organization Name:CUTTING EDGE ORTHOPEDIC & SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENEANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WAKULA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-263-1642
Mailing Address - Street 1:9044 SE BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HOBE SOUND
Mailing Address - State:FL
Mailing Address - Zip Code:33455-5313
Mailing Address - Country:US
Mailing Address - Phone:772-546-9591
Mailing Address - Fax:772-546-9535
Practice Address - Street 1:4711 SCENIC HWY
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-9018
Practice Address - Country:US
Practice Address - Phone:772-546-9591
Practice Address - Fax:772-546-9535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty