Axis Professional Labs LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

37D2122926 Issued in OK

Legal business name

AXIS PROFESSIONAL LABS LLC

Doing business as

Kingdom Health Laboratory

Practice address

4887 Alpha Rd Ste 220
Farmers Branch, TX 75244-4632

Phone

(469) 995-7792

Fax

(469) 995-8238

NPI assigned

Feb 3, 2017

Last updated

Aug 29, 2022By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Keith J Gray

Title

Officer

Phone

(469) 995-7792

Specialties & licenses 1

Addresses

Other names 1

• Kingdom Health Laboratory Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1486080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661731200000",
    "number": "1255879763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 250989",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750250989",
            "telephone_number": "469-995-7792",
            "fax_number": "469-995-8238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4887 ALPHA RD STE 220",
            "city": "FARMERS BRANCH",
            "state": "TX",
            "postal_code": "752444632",
            "telephone_number": "469-995-7792",
            "fax_number": "469-995-8238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AXIS PROFESSIONAL LABS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-03",
        "last_updated": "2022-08-29",
        "certification_date": "2022-08-29",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "469-995-7792"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "OK",
            "license": "37D2122926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kingdom Health Laboratory",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Clinical Medical Laboratory in Farmers Branch, TX
• Providers in Farmers Branch, TX by specialty
• Clinical Medical Laboratory in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.