Provider Demographics
NPI:1326215153
Name:AXIS HEALTHCARE
Entity Type:Organization
Organization Name:AXIS HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF SPECIAL PROJECTS
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-556-9379
Mailing Address - Street 1:2356 UNIVERSITY AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1853
Mailing Address - Country:US
Mailing Address - Phone:651-556-0880
Mailing Address - Fax:
Practice Address - Street 1:2356 UNIVERSITY AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1853
Practice Address - Country:US
Practice Address - Phone:651-556-0880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management