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General NPI Number Information
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NPI Number | 1063233583
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Entity Type | Organization
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Legal Business Name | CUTTING EDGE SURGICAL SERVICES, LLC
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Dates
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Enumeration Date | 10/17/2024
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 2840 CLARK AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63103-2506
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Country | US
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Telephone | 314-949-3066
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Fax |
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Provider Business Mailing Address
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Address Line | 2796 KINGS CROSSING DR
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City | BARNHART
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State | MO
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Zip | 63012-1174
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | RNFA
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Name | JAMES THACKER
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Credential |
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Telephone | 314-724-8961
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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