1417926106 NPI number — AXIS MEDICAL EQUIPMENT & SUPPLY, LLC

Table of content: (NPI 1417926106)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417926106 NPI number — AXIS MEDICAL EQUIPMENT & SUPPLY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AXIS MEDICAL EQUIPMENT & SUPPLY, LLC
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:
1417926106
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3214 BELT LINE RD STE 426
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARMERS BRANCH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75234-2326
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-889-2947
Provider Business Mailing Address Fax Number:
972-767-4762

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3214 BELT LINE RD STE 426
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARMERS BRANCH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75234-2326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-889-2947
Provider Business Practice Location Address Fax Number:
972-767-4762
Provider Enumeration Date:
03/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MANAGING DIRECTOR
Authorized Official Telephone Number:
972-889-2947

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 159362601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 531726 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".