Provider Demographics
NPI:1114189446
Name:AXIS INCORPORATED LLC
Entity Type:Organization
Organization Name:AXIS INCORPORATED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAROMI
Authorized Official - Middle Name:
Authorized Official - Last Name:DHUPAR-SAKURAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-818-6190
Mailing Address - Street 1:1816 SEA SHELL CT
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550
Mailing Address - Country:US
Mailing Address - Phone:970-818-6190
Mailing Address - Fax:970-460-0581
Practice Address - Street 1:1816 SEA SHELL CT
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550
Practice Address - Country:US
Practice Address - Phone:970-818-6190
Practice Address - Fax:970-460-0581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZE0600X, 293D00000X
CO1512363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty
No293D00000XLaboratoriesPhysiological LaboratoryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty