MEDICARE: AXIA MEDICAL LLC

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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1750250148
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AXIA MEDICAL LLC

Provider Business Mailing Address
First Line	:	955 PARK AVE STE B
Second Line	:
City	:	LAKE PARK
State	:	FL
Zip	:	33403-2405
Country	:	US
Telephone Number	:	347-481-3267
Fax Number	:	347-481-3267

Provider Business Practice Location Address
First Line	:	955 PARK AVE STE B
Second Line	:
City	:	LAKE PARK
State	:	FL
Zip	:	33403-2405
Country	:	US
Telephone Number	:	347-481-3267
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	ROSELENE JEAN
Credential	:
Telephone Number	:	347-481-3267

Provider Enumeration Date	:	11/03/2025
Last Update Date	:	05/04/2026

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Directions to “AXIA MEDICAL LLC ” Practice Location

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