Provider Demographics
NPI:1881867596
Name:CUTTING EDGE HISTOLOGY SERVICES LLC
Entity Type:Organization
Organization Name:CUTTING EDGE HISTOLOGY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:M
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:MESA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:503-268-4805
Mailing Address - Street 1:PO BOX 4207
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4207
Mailing Address - Country:US
Mailing Address - Phone:503-268-4805
Mailing Address - Fax:503-268-4801
Practice Address - Street 1:8192 SW DURHAM RD
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-7315
Practice Address - Country:US
Practice Address - Phone:503-268-4805
Practice Address - Fax:503-268-4801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227673Medicaid
ORP00076463Medicare PIN
ORR116399Medicare PIN