Provider Demographics
NPI:1346014602
Name:AXIAL CLINIC IA PC
Entity Type:Organization
Organization Name:AXIAL CLINIC IA PC
Other - Org Name:WAYSPRING CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHEF LEGAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEYWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-345-3555
Mailing Address - Street 1:209 10TH AVE S STE 350
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-4166
Mailing Address - Country:US
Mailing Address - Phone:615-345-3555
Mailing Address - Fax:
Practice Address - Street 1:501 SW 7TH ST STE A
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-4538
Practice Address - Country:US
Practice Address - Phone:515-304-5505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AXIAL CLINIC IA PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-08
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty