Healthcare Provider Details

I. General information

NPI: 1902125784
Provider Name (Legal Business Name): AXIOM LIMITED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 05/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 WEST BELLWOOD LN
MURRAY UT
84123
US

IV. Provider business mailing address

1030 WEST BELLWOOD LN
MURRAY UT
84123
US

V. Phone/Fax

Practice location:
  • Phone: 801-506-5012
  • Fax: 801-747-3088
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number7529823-1714
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. FRANK FULLMER
Title or Position: CEO
Credential:
Phone: 801-856-2826