Healthcare Provider Details

I. General information

NPI: 1790103455
Provider Name (Legal Business Name): A CUT ABOVE SURGICAL ASSISTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 03/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6313 E COMMERCIAL ST
BROKEN ARROW OK
74014-6981
US

IV. Provider business mailing address

6313 E COMMERCIAL ST
BROKEN ARROW OK
74014-6981
US

V. Phone/Fax

Practice location:
  • Phone: 918-595-2331
  • Fax: 918-893-1592
Mailing address:
  • Phone: 918-595-2331
  • Fax: 918-893-1592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number140237
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. KATIE LEIGH ELLIOTT
Title or Position: OWNER
Credential: CSFA
Phone: 918-595-2331