Provider Demographics
NPI:1972917359
Name:AXIS MEDICAL CENTER CORP
Entity Type:Organization
Organization Name:AXIS MEDICAL CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ERENDIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:DELGADO
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:305-877-8184
Mailing Address - Street 1:8396 SW 8TH ST
Mailing Address - Street 2:SUITE 216
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4180
Mailing Address - Country:US
Mailing Address - Phone:305-779-2435
Mailing Address - Fax:786-272-5909
Practice Address - Street 1:8396 SW 8TH ST
Practice Address - Street 2:SUITE 216
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4180
Practice Address - Country:US
Practice Address - Phone:305-779-2435
Practice Address - Fax:786-272-5909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10099261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty