Healthcare Provider Details

I. General information

NPI: 1346286036
Provider Name (Legal Business Name): AXTELL CLINIC, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 MEDICAL CENTER DRIVE SUITE 210
NEWTON KS
67114-9017
US

IV. Provider business mailing address

700 MEDICAL CENTER DRIVE SUITE 210
NEWTON KS
67114-9017
US

V. Phone/Fax

Practice location:
  • Phone: 316-283-2800
  • Fax: 316-283-3575
Mailing address:
  • Phone: 316-283-2800
  • Fax: 316-283-3575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ALISHA MALO
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 316-283-2800