Provider Demographics
NPI:1083818744
Name:AXIS MEDICAL SUPPLY
Entity Type:Organization
Organization Name:AXIS MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:VEILLEUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-603-3616
Mailing Address - Street 1:P O BOX 221347
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79913
Mailing Address - Country:US
Mailing Address - Phone:915-603-3616
Mailing Address - Fax:
Practice Address - Street 1:5360 N MESA ST
Practice Address - Street 2:SUITE J10
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-5872
Practice Address - Country:US
Practice Address - Phone:915-603-3616
Practice Address - Fax:915-533-3031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-14
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0096015332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX532595OtherBCBS OF TEXAS
TX9329076OtherAETNA
TX9329076OtherAETNA