Basic Information
| Provider Information | |||||||||
| NPI: | 1225639487 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AXIS NEUROMONITORING SA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1819 JAY ELL DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | RICHARDSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750812064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8883442947 | ||||||||
| FaxNumber: | 8886942947 | ||||||||
| Practice Location | |||||||||
| Address1: | 1819 JAY ELL DR STE 100 | ||||||||
| Address2: | |||||||||
| City: | RICHARDSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750812064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8883442947 | ||||||||
| FaxNumber: | 8886942947 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2020 | ||||||||
| LastUpdateDate: | 11/04/2020 | ||||||||
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| AuthorizedOfficialLastName: | BANES | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 4696093611 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZE0600X | Y | 193400000X SINGLE SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Electroneurodiagnostic |
No ID Information.