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General NPI Number Information
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NPI Number | 1639662570
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Entity Type | Organization
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Legal Business Name | AXIOM PSYCHIATRY LLC
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Dates
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Enumeration Date | 06/13/2018
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Last Update Date | 08/03/2020
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Provider Practice Location Address
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Address Line | 13780 E RICE PL STE 103
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City | AURORA
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State | CO
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Zip | 80015-1257
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Country | US
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Telephone | 722-575-5400
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Fax | 720-709-1161
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Provider Business Mailing Address
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Address Line | 13780 E RICE PL STE 103
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City | AURORA
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State | CO
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Zip | 80015-1257
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Country | US
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Telephone | 720-575-5400
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Fax | 720-709-1161
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | CLINT TANNER
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Credential | MD
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Telephone | 720-575-5400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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