MEDICARE: AXIS DIAGNOSTICS, INC.

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	291U00000X	Clinical Medical Laboratory
2	291U00000X	Clinical Medical Laboratory		TX

General Provider Information

NPI Number	:	1730599416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AXIS DIAGNOSTICS, INC.

Provider Business Mailing Address
First Line	:	1077 CENTRAL PARKWAY SOUTH
Second Line	:	SUITE 200
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-5054
Country	:	US
Telephone Number	:	210-375-3231
Fax Number	:	210-375-3194

Provider Business Practice Location Address
First Line	:	1077 CENTRAL PARKWAY SOUTH
Second Line	:	SUITE 200
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-5054
Country	:	US
Telephone Number	:	210-375-3231
Fax Number	:	210-375-3194

Authorized Official
Title or Position	:	CEO
Name	:	DR. WILLIAM W WHITE
Credential	:	M.D.
Telephone Number	:	210-375-3231

Provider Enumeration Date	:	05/02/2014
Last Update Date	:	12/26/2014

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