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General NPI Number Information
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NPI Number | 1346286036
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Entity Type | Organization
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Legal Business Name | AXTELL CLINIC, PA
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Dates
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Enumeration Date | 06/21/2006
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Last Update Date | 01/14/2021
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Provider Practice Location Address
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Address Line | 700 MEDICAL CENTER DRIVE SUITE 210
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City | NEWTON
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State | KS
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Zip | 67114-9017
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Country | US
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Telephone | 316-283-2800
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Fax | 316-283-3575
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Provider Business Mailing Address
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Address Line | 700 MEDICAL CENTER DRIVE SUITE 210
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City | NEWTON
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State | KS
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Zip | 67114-9017
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Country | US
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Telephone | 316-283-2800
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Fax | 316-283-3575
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ALISHA MALO
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Credential | RN
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Telephone | 316-283-2800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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