Provider Demographics
NPI:1619569654
Name:AXIOM CLINIC SC
Entity Type:Organization
Organization Name:AXIOM CLINIC SC
Other - Org Name:KIDS HEART CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-345-5255
Mailing Address - Street 1:7015 E CENTRAL AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1946
Mailing Address - Country:US
Mailing Address - Phone:316-440-8800
Mailing Address - Fax:316-440-8802
Practice Address - Street 1:2111 NORTHWINDS DR
Practice Address - Street 2:
Practice Address - City:DYER
Practice Address - State:IN
Practice Address - Zip Code:46311-1882
Practice Address - Country:US
Practice Address - Phone:630-345-5255
Practice Address - Fax:630-323-9044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-10
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty