Provider Demographics
NPI:1104868462
Name:AXIS NEPHROLOGY PLLC
Entity type:Organization
Organization Name:AXIS NEPHROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING- BILLING SPECIALIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:DEMPSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-272-5881
Mailing Address - Street 1:1708 S YAKIMA AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405
Mailing Address - Country:US
Mailing Address - Phone:253-272-5881
Mailing Address - Fax:253-383-0161
Practice Address - Street 1:1708 S YAKIMA AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:253-272-5881
Practice Address - Fax:253-383-0161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040610207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7128556Medicaid
WA7128556Medicaid