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General NPI Number Information
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NPI Number | 1255973707
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Entity Type | Organization
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Legal Business Name | AXIVA INFUSION CENTERS - WV LLC
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Dates
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Enumeration Date | 10/16/2019
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Last Update Date | 10/16/2019
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Provider Practice Location Address
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Address Line | 93 CRIMSON CIR
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City | MARTINSBURG
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State | WV
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Zip | 25403-6397
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Country | US
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Telephone | 304-885-1500
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Fax | 304-885-1501
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Provider Business Mailing Address
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Address Line | 1120 W TOWNSHIP LINE RD STE 300
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City | HAVERTOWN
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State | PA
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Zip | 19083-4929
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Country | US
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Telephone | 610-601-0760
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Fax | 610-756-0670
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Authorized Official
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Title or Position | VP OF REVENUE CYCLE
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Name | JENNY HUSTEK
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Credential |
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Telephone | 610-609-7399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QI0500X
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Taxonomy Name | Infusion Therapy Clinic/Center
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License Number |
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License Number State |
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