Provider Demographics
NPI:1659389997
Name:AXISCARE HEALTH LOGISTICS INC
Entity Type:Organization
Organization Name:AXISCARE HEALTH LOGISTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:ISMARO
Authorized Official - Last Name:MARRERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-251-2323
Mailing Address - Street 1:PO BOX 1366
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-1366
Mailing Address - Country:US
Mailing Address - Phone:787-251-2323
Mailing Address - Fax:787-251-2323
Practice Address - Street 1:CARR 2 KM 19.5 PEPSI INDUSTRIAL PARK #1
Practice Address - Street 2:CANDELARIA
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-251-2323
Practice Address - Fax:787-251-2323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
PR335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR4916260001Medicare NSC