Organization
AXIS CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LANCE M NORMAN OTR/L, CHT (PRESIDENT)
(701) 792-2947
Entity
Organization
Contact information
Practice address
1451 44TH AVE S STE 120D, GRAND FORKS, ND 58201-3434
(701) 732-2947
(701) 732-4945
Mailing address
1451 44TH AVE S STE 120D, GRAND FORKS, ND 58201-3434
(701) 732-2947
(701) 732-2945
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
25
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01042277
PREFERRED ONE
—
01
—
115081
HEALTH PARTNERS
—
01
—
2476885
UNITED HEALTH CARE
—
01
—
26105
BLUE CROSS BLUE SHIELD
ND
05
—
50900
—
ND
01
—
548G3AX
BLUE CROSS BLUE SHIELD
MN
05
—
54900
—
ND
01
—
700A8AX
BLUE CROSS BLUE SHIELD
MN
Enumeration date
06/02/2006
Last updated
12/26/2007
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