Provider Demographics
NPI:1164039632
Name:AXIOM MEDICAL SOLUTIONS, LLC
Entity Type:Organization
Organization Name:AXIOM MEDICAL SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:TROY
Authorized Official - Last Name:BRAUDWAY
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:405-615-3245
Mailing Address - Street 1:14132 SE 134TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73165-7669
Mailing Address - Country:US
Mailing Address - Phone:405-615-3245
Mailing Address - Fax:
Practice Address - Street 1:14132 SE 134TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73165-7669
Practice Address - Country:US
Practice Address - Phone:405-615-3245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty