Provider Demographics
NPI:1669475539
Name:AXTELL ORTHOPEDICS PA
Entity Type:Organization
Organization Name:AXTELL ORTHOPEDICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:C
Authorized Official - Last Name:CRAIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-283-9977
Mailing Address - Street 1:800 MEDICAL CENTER DRIVE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114
Mailing Address - Country:US
Mailing Address - Phone:316-283-9977
Mailing Address - Fax:316-283-0966
Practice Address - Street 1:800 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 240
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-7808
Practice Address - Country:US
Practice Address - Phone:316-283-9977
Practice Address - Fax:316-283-0966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSB68848Medicare UPIN