MEDICARE: AXIVA INFUSION CENTERS - HT 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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1972065043
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AXIVA INFUSION CENTERS - HT LLC

Provider Business Mailing Address
First Line	:	1120 W TOWNSHIP LINE RD STE 300
Second Line	:
City	:	HAVERTOWN
State	:	PA
Zip	:	19083-4929
Country	:	US
Telephone Number	:	610-601-0760
Fax Number	:	610-756-0670

Provider Business Practice Location Address
First Line	:	2010 W CHESTER PIKE STE 438
Second Line	:
City	:	HAVERTOWN
State	:	PA
Zip	:	19083-2740
Country	:	US
Telephone Number	:	844-442-9482
Fax Number	:	844-440-0101

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	COLLEEN S SHAPIRO
Credential	:
Telephone Number	:	844-442-9482

Provider Enumeration Date	:	04/05/2019
Last Update Date	:	10/21/2025

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