Provider Demographics
NPI:1285105932
Name:CURRENT EDGE LLC
Entity type:Organization
Organization Name:CURRENT EDGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMP
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:505-886-2025
Mailing Address - Street 1:9723 MENAUL BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2363
Mailing Address - Country:US
Mailing Address - Phone:505-886-2025
Mailing Address - Fax:505-718-4976
Practice Address - Street 1:9723 MENAUL BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2363
Practice Address - Country:US
Practice Address - Phone:505-886-2025
Practice Address - Fax:505-718-4976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-06
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM33437572Medicaid