Healthcare Provider Details

I. General information

NPI: 1053077990
Provider Name (Legal Business Name): AXCES HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2021
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 HARKLE RD STE B
SANTA FE NM
87505-4753
US

IV. Provider business mailing address

531 HARKLE RD STE B
SANTA FE NM
87505-4753
US

V. Phone/Fax

Practice location:
  • Phone: 505-207-8078
  • Fax: 505-207-8082
Mailing address:
  • Phone: 505-207-8078
  • Fax: 505-207-8082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: LAURIE BAUER
Title or Position: SENIOR DIRECTOR OF OPERATIONS
Credential:
Phone: 505-207-8078