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General NPI Number Information
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NPI Number | 1285841577
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Entity Type | Organization
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Legal Business Name | VAXXIM INC.
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 610 RUSTIC ST
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City | OPELIKA
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State | AL
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Zip | 36801-3434
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Country | US
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Telephone | 334-319-3279
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Fax |
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Provider Business Mailing Address
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Address Line | 610 RUSTIC ST
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City | OPELIKA
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State | AL
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Zip | 36801-3434
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Country | US
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Telephone | 334-319-3279
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | GARY A WOOD
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Credential | RN
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Telephone | 334-319-3279
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | 1-066975
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License Number State | AL
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