Healthcare Provider Details

I. General information

NPI: 1194262964
Provider Name (Legal Business Name): AXIS MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 05/22/2020
Certification Date: 05/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BOSA DR SUITE F
SAINT ROBERT MO
65584-4833
US

IV. Provider business mailing address

100 BOSA DR SUITE F
SAINT ROBERT MO
65584-4833
US

V. Phone/Fax

Practice location:
  • Phone: 573-337-0694
  • Fax:
Mailing address:
  • Phone: 573-337-0694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DANIEL DRAPER
Title or Position: OWNER
Credential: COTA
Phone: 573-337-0694