Provider Demographics
NPI:1669403390
Name:AXIS COMMUNITY HEALTH INC
Entity type:Organization
Organization Name:AXIS COMMUNITY HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:COMPTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-462-1755
Mailing Address - Street 1:5925 W LAS POSITAS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-8537
Mailing Address - Country:US
Mailing Address - Phone:925-462-1755
Mailing Address - Fax:925-417-1503
Practice Address - Street 1:4361 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-6611
Practice Address - Country:US
Practice Address - Phone:925-462-5544
Practice Address - Fax:925-201-6016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140000043261QC1500X
CAA0610721261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC11593FMedicaid
CAFHC11593FMedicaid
CA551018Medicare Oscar/Certification