Provider Demographics
NPI:1386807444
Name:AXCESS MEDICAL CLINIC, INC
Entity type:Organization
Organization Name:AXCESS MEDICAL CLINIC, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:504-909-4554
Mailing Address - Street 1:PO BOX 6673
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70009-6673
Mailing Address - Country:US
Mailing Address - Phone:504-734-2393
Mailing Address - Fax:504-467-6002
Practice Address - Street 1:524 ELMWOOD PARK BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:HARAHAN
Practice Address - State:LA
Practice Address - Zip Code:70123-3339
Practice Address - Country:US
Practice Address - Phone:504-734-2393
Practice Address - Fax:504-467-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0264302081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty