Healthcare Provider Details

I. General information

NPI: 1710374475
Provider Name (Legal Business Name): AXIOM HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2015
Last Update Date: 04/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 W 13TH ST N STE 10
WICHITA KS
67212-2968
US

IV. Provider business mailing address

7200 W 13TH ST N STE 10
WICHITA KS
67212-2968
US

V. Phone/Fax

Practice location:
  • Phone: 316-448-0850
  • Fax:
Mailing address:
  • Phone: 316-448-0850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number31400000X
License Number StateKS

VIII. Authorized Official

Name: MRS. PAULA A VARNER
Title or Position: EXECUTIVE ASSISTANT
Credential:
Phone: 316-448-0850