Healthcare Provider Details

I. General information

NPI: 1386060077
Provider Name (Legal Business Name): AXTMAN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2014
Last Update Date: 03/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5009 S WESTERN AVE STE 220
SIOUX FALLS SD
57108-5084
US

IV. Provider business mailing address

5009 S WESTERN AVE STE 220
SIOUX FALLS SD
57108-5084
US

V. Phone/Fax

Practice location:
  • Phone: 605-275-9183
  • Fax: 605-275-9184
Mailing address:
  • Phone: 605-275-9183
  • Fax: 605-275-9184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberDB057712
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberDB057712
License Number StateSD
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberDB057712
License Number StateSD

VIII. Authorized Official

Name: MR. DAVID DAVIS AXTMAN
Title or Position: PRESIDENT
Credential: MPAS, PA-C
Phone: 605-275-9183