Provider Demographics
NPI:1093531972
Name:AXIS HEALTH SOURCE LLC
Entity type:Organization
Organization Name:AXIS HEALTH SOURCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-288-1545
Mailing Address - Street 1:11890 SW 8TH ST STE 408
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-1700
Mailing Address - Country:US
Mailing Address - Phone:888-288-1545
Mailing Address - Fax:888-288-1589
Practice Address - Street 1:11890 SW 8TH ST STE 408
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-1700
Practice Address - Country:US
Practice Address - Phone:888-288-1545
Practice Address - Fax:888-288-1589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies