Provider Demographics
NPI:1326714288
Name:AXIS SPINE CLINIC, LLC
Entity Type:Organization
Organization Name:AXIS SPINE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:BERG
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:614-468-5333
Mailing Address - Street 1:800 CROSS POINTE RD STE I
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-6688
Mailing Address - Country:US
Mailing Address - Phone:614-468-5333
Mailing Address - Fax:614-428-0899
Practice Address - Street 1:800 CROSS POINTE RD STE I
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-6688
Practice Address - Country:US
Practice Address - Phone:614-468-5333
Practice Address - Fax:614-428-0899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-20
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty