Provider Demographics
NPI:1942625413
Name:AXIS HEALTHCARE
Entity Type:Organization
Organization Name:AXIS HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:BACHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-556-9399
Mailing Address - Street 1:2356 UNIVERSITY AVE W
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1853
Mailing Address - Country:US
Mailing Address - Phone:651-556-0887
Mailing Address - Fax:651-556-0880
Practice Address - Street 1:2356 UNIVERSITY AVE W
Practice Address - Street 2:SUITE 210
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1853
Practice Address - Country:US
Practice Address - Phone:651-556-0887
Practice Address - Fax:651-556-0880
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLINA HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-20
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNA644623100OtherUMPI