MEDICARE: AXTELL ORTHOPEDICS PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1669475539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AXTELL ORTHOPEDICS PA

Provider Business Mailing Address
First Line	:	800 MEDICAL CENTER DRIVE
Second Line	:	SUITE 240
City	:	NEWTON
State	:	KS
Zip	:	67114
Country	:	US
Telephone Number	:	316-283-9977
Fax Number	:	316-283-0966

Provider Business Practice Location Address
First Line	:	800 MEDICAL CENTER DR
Second Line	:	SUITE 240
City	:	NEWTON
State	:	KS
Zip	:	67114-7808
Country	:	US
Telephone Number	:	316-283-9977
Fax Number	:	316-283-0966

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHARLES C CRAIG
Credential	:	MD
Telephone Number	:	316-283-9977

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	06/02/2008

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