Provider Demographics
NPI:1912579103
Name:AXIS HEALTHCARE CLINICS
Entity Type:Organization
Organization Name:AXIS HEALTHCARE CLINICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-528-9947
Mailing Address - Street 1:500 N RAINBOW BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89107-1061
Mailing Address - Country:US
Mailing Address - Phone:702-389-1148
Mailing Address - Fax:702-389-1149
Practice Address - Street 1:4375 LAS VEGAS BLVD N STE 9
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-0587
Practice Address - Country:US
Practice Address - Phone:702-410-5510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100550403Medicaid