NPIMap

Organization Active NPI

Axolotl, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Harrisburg, IL
National Provider Identifier
1609136019
Registry record updated May 18, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
AXOLOTL, LLC
Practice address
130 E Clark St
Harrisburg, IL 62946-2700
Phone
(618) 922-9952
NPI assigned
May 18, 2012
Last updated
May 18, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2012

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

Authorized official

Name
Kevin ChenNPI 1740291780
Title
Owner
Phone
(618) 922-9952

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X Primary

Addresses

Primary practice location

130 E Clark St
Harrisburg, IL 62946-2700

Mailing address

1507 Gleneagle Dr
Marion, IL 62959-5231

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1337299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337299200000",
    "number": "1609136019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1507 GLENEAGLE DR",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629595231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 E CLARK ST",
            "city": "HARRISBURG",
            "state": "IL",
            "postal_code": "629462700",
            "telephone_number": "618-922-9952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AXOLOTL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-18",
        "last_updated": "2012-05-18",
        "status": "A",
        "authorized_official_last_name": "CHEN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "618-922-9952"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Harrisburg, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.