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General NPI Number Information
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NPI Number | 1962353656
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Entity Type | Organization
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Legal Business Name | ROOT CAUSE MEDICAL CLINIC LLC
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Dates
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Enumeration Date | 02/07/2026
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Last Update Date | 02/09/2026
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Provider Practice Location Address
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Address Line | 15049 BRUCE B DOWNS BLVD
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City | TAMPA
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State | FL
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Zip | 33647-1388
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Country | US
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Telephone | 813-563-7668
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Fax |
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Provider Business Mailing Address
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Address Line | 15049 BRUCE B DOWNS BLVD
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City | TAMPA
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State | FL
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Zip | 33647-1388
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Country | US
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Telephone | 813-563-7668
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JORDAN AXE
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Credential |
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Telephone | 937-216-9044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number |
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License Number State |
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