MEDICARE: AXIS HEALTHCARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1326215153
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AXIS HEALTHCARE

Provider Business Mailing Address
First Line	:	2356 UNIVERSITY AVE W
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1853
Country	:	US
Telephone Number	:	651-556-0880
Fax Number	:

Provider Business Practice Location Address
First Line	:	2356 UNIVERSITY AVE W
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1853
Country	:	US
Telephone Number	:	651-556-0880
Fax Number	:

Authorized Official
Title or Position	:	MANAGER OF SPECIAL PROJECTS
Name	:	MRS. TERESA BLY
Credential	:
Telephone Number	:	651-556-9379

Provider Enumeration Date	:	05/12/2008
Last Update Date	:	05/12/2008

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Practice Location Address:

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Practice Fax: 651-556-0880

Directions to “AXIS HEALTHCARE ” Practice Location

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