Provider Demographics
NPI:1194262964
Name:AXIS MEDICAL, LLC
Entity type:Organization
Organization Name:AXIS MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAPER
Authorized Official - Suffix:
Authorized Official - Credentials:COTA
Authorized Official - Phone:573-337-0694
Mailing Address - Street 1:100 BOSA DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:SAINT ROBERT
Mailing Address - State:MO
Mailing Address - Zip Code:65584-4833
Mailing Address - Country:US
Mailing Address - Phone:573-337-0694
Mailing Address - Fax:
Practice Address - Street 1:100 BOSA DR
Practice Address - Street 2:SUITE F
Practice Address - City:SAINT ROBERT
Practice Address - State:MO
Practice Address - Zip Code:65584-4833
Practice Address - Country:US
Practice Address - Phone:573-337-0694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies