Provider Demographics
NPI:1427790914
Name:AXIAL CLINIC IN PC
Entity type:Organization
Organization Name:AXIAL CLINIC IN PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF LEGAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:HEYWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-231-8560
Mailing Address - Street 1:209 10TH AVE S STE 332
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-0752
Mailing Address - Country:US
Mailing Address - Phone:615-231-8560
Mailing Address - Fax:317-245-8706
Practice Address - Street 1:3660 GUION RD STE 210
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-1691
Practice Address - Country:US
Practice Address - Phone:317-688-1327
Practice Address - Fax:317-245-8706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-13
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty