Provider Demographics
NPI:1235653387
Name:QUANTUM AXIS LLC
Entity Type:Organization
Organization Name:QUANTUM AXIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:LAZARUS
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:MUKUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-508-1438
Mailing Address - Street 1:9828 TORRINGTON DR N
Mailing Address - Street 2:
Mailing Address - City:SEMMES
Mailing Address - State:AL
Mailing Address - Zip Code:36575-8206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9828 TORRINGTON DR N
Practice Address - Street 2:
Practice Address - City:SEMMES
Practice Address - State:AL
Practice Address - Zip Code:36575-8206
Practice Address - Country:US
Practice Address - Phone:251-508-1438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-31
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)