Axis Rejuvenation LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

AXIS REJUVENATION LLC

Practice address

100 Bosa Dr Ste a
Saint Robert, MO 65584-4833

Phone

(573) 337-4568

Fax

(573) 336-2256

NPI assigned

Aug 31, 2018

Organization subpart

No

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

Authorized official

Name

Daniel Draper

Title

Partner

Phone

(801) 953-5323

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1535673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577664000000",
    "number": "1972085371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 BOSA DR STE A",
            "city": "SAINT ROBERT",
            "state": "MO",
            "postal_code": "655844833",
            "telephone_number": "801-953-5323",
            "fax_number": "801-336-2256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 BOSA DR STE A",
            "city": "SAINT ROBERT",
            "state": "MO",
            "postal_code": "655844833",
            "telephone_number": "573-337-4568",
            "fax_number": "573-336-2256"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Bosa Dr Ste A",
            "address_purpose": "LOCATION",
            "city": "Saint Robert",
            "state": "MO",
            "postal_code": "655844833",
            "country_code": "US",
            "telephone_number": "801-953-5323",
            "fax_number": "801-336-2256",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "AXIS REJUVENATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-31",
        "last_updated": "2019-12-30",
        "certification_date": "2019-12-30",
        "status": "A",
        "authorized_official_last_name": "DRAPER",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "801-953-5323"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Jeffrey Allen, FNP-BC
• American Homepatient, Inc.
• Cynthia Anne Armistead, MSCCC-SLP
• Destiny Nicole Aviles
• Axis Medical, LLC
• Axis Sleep Center, LLC
• Rachel Erin Bagot, DMD
• Jordan Wayne Bailey
• Rosie Ball
• Jacqueline Barber

• All providers in Saint Robert, MO
• Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2019; 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.