1508378944 NPI number — AXON PROTECTIVE SERVICES, PLLC

Table of content: (NPI 1508378944)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508378944 NPI number — AXON PROTECTIVE SERVICES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AXON PROTECTIVE SERVICES, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508378944
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1141 N LOOP 1604 E #105-612
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-598-4277
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4120 W MEMORIAL RD STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-598-4277
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/25/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LAROQUE
Authorized Official First Name:
ROXANNA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF CLIENT EXPERIENCE
Authorized Official Telephone Number:
210-598-4277

Provider Taxonomy Codes

  • Taxonomy code: 204R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084N0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 246ZE0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)