Provider Demographics
NPI:1811921067
Name:CUTTING EDGE MEDICAL LLC
Entity type:Organization
Organization Name:CUTTING EDGE MEDICAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-640-0202
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418-0249
Mailing Address - Country:US
Mailing Address - Phone:903-640-0202
Mailing Address - Fax:903-640-0223
Practice Address - Street 1:2620 N CENTER ST
Practice Address - Street 2:STE 103 A
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-2100
Practice Address - Country:US
Practice Address - Phone:903-640-0202
Practice Address - Fax:903-640-0223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5594470001Medicare NSC