Healthcare Provider Details

I. General information

NPI: 1093013310
Provider Name (Legal Business Name): AXIS NEUROMONITORING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2011
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1819 JAY ELL DR STE 100
RICHARDSON TX
75081-1837
US

IV. Provider business mailing address

1819 JAY ELL DR STE 100
RICHARDSON TX
75081-1837
US

V. Phone/Fax

Practice location:
  • Phone: 888-344-2947
  • Fax: 888-694-2947
Mailing address:
  • Phone: 888-344-2947
  • Fax: 888-694-2947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number
License Number StateTX

VIII. Authorized Official

Name: EDWARD LEE TRAWEEK
Title or Position: PART OWNER
Credential:
Phone: 888-344-2947