Provider Demographics
NPI:1265595656
Name:AXIS MEDICAL & FITNESS EQUIPMENT
Entity type:Organization
Organization Name:AXIS MEDICAL & FITNESS EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:CUPPLES
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:318-427-9030
Mailing Address - Street 1:1616 EVARIST ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3414
Mailing Address - Country:US
Mailing Address - Phone:318-427-9030
Mailing Address - Fax:318-427-1818
Practice Address - Street 1:1616 EVARIST ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3414
Practice Address - Country:US
Practice Address - Phone:318-427-9030
Practice Address - Fax:318-427-1818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA00107187332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1459615Medicaid
LA5873640001Medicare NSC