MEDICARE: AXIS ORTHOTICS AND PROSTHETICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Z00000X	Orthotist
2	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1184390106
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AXIS ORTHOTICS AND PROSTHETICS LLC

Provider Business Mailing Address
First Line	:	11261 RICHMOND AVE, BLDG. G, STE 102
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77082-2676
Country	:	US
Telephone Number	:	281-809-3600
Fax Number	:	281-809-3007

Provider Business Practice Location Address
First Line	:	11261 RICHMOND AVE
Second Line	:	BLDG. G, STE. 102
City	:	HOUSTON
State	:	TX
Zip	:	77082-2676
Country	:	US
Telephone Number	:	281-809-3600
Fax Number	:	281-809-3007

Authorized Official
Title or Position	:	MANAGER
Name	:	WILLIAM E HEARN
Credential	:	C.O., L.P.O.
Telephone Number	:	281-809-3600

Provider Enumeration Date	:	08/19/2021
Last Update Date	:	10/06/2021

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