Provider Demographics
NPI:1255973707
Name:AXIVA INFUSION CENTERS - WV LLC
Entity type:Organization
Organization Name:AXIVA INFUSION CENTERS - WV LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSTEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-609-7399
Mailing Address - Street 1:1120 W TOWNSHIP LINE RD STE 300
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-4929
Mailing Address - Country:US
Mailing Address - Phone:610-601-0760
Mailing Address - Fax:610-756-0670
Practice Address - Street 1:93 CRIMSON CIR
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25403-6397
Practice Address - Country:US
Practice Address - Phone:304-885-1500
Practice Address - Fax:304-885-1501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy