Provider Demographics
NPI:1730599416
Name:AXIS DIAGNOSTICS, INC.
Entity type:Organization
Organization Name:AXIS DIAGNOSTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:W
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-375-3231
Mailing Address - Street 1:1077 CENTRAL PARKWAY SOUTH
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-5054
Mailing Address - Country:US
Mailing Address - Phone:210-375-3231
Mailing Address - Fax:210-375-3194
Practice Address - Street 1:1077 CENTRAL PARKWAY SOUTH
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-5054
Practice Address - Country:US
Practice Address - Phone:210-375-3231
Practice Address - Fax:210-375-3194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-02
Last Update Date:2014-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
291U00000X
TX291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX351147Medicare PIN