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General NPI Number Information
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NPI Number | 1912516402
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Entity Type | Organization
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Legal Business Name | AXIOM, LLC
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Dates
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Enumeration Date | 07/30/2020
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Last Update Date | 07/30/2020
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Provider Practice Location Address
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Address Line | 575 LOS ALTOS CIR
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City | MESQUITE
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State | NV
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Zip | 89027-2523
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Country | US
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Telephone | 701-388-5390
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1789
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City | CROSBY
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State | TX
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Zip | 77532-1789
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Country | US
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Telephone | 281-346-3480
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Fax | 281-462-4106
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Authorized Official
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Title or Position | OWNER
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Name | JAMES TRITCHLER
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Credential |
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Telephone | 701-388-5390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number |
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License Number State |
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