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General NPI Number Information
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NPI Number | 1457804197
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Entity Type | Organization
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Legal Business Name | AXIS FORENSIC TOXICOLOGY, INC.
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Dates
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Enumeration Date | 07/29/2016
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Last Update Date | 07/29/2016
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Provider Practice Location Address
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Address Line | 2265 EXECUTIVE DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46241-4352
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Country | US
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Telephone | 317-759-4869
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 681513
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City | INDIANAPOLIS
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State | IN
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Zip | 46268-7513
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP, COO
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Name | DENISE PURDIE ANDREWS
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Credential |
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Telephone | 317-759-4869
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 9472384
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License Number State | IN
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