Healthcare Provider Details

I. General information

NPI: 1104028273
Provider Name (Legal Business Name): AXIS PROSTHETICS AND ORTHOTICS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 JEFFERSON ST
WHITEVILLE NC
28472-3706
US

IV. Provider business mailing address

1142 SHIPYARD BLVD
WILMINGTON NC
28412-6439
US

V. Phone/Fax

Practice location:
  • Phone: 910-640-2039
  • Fax: 910-640-3938
Mailing address:
  • Phone: 910-350-0067
  • Fax: 910-350-0065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY MCDONALD
Title or Position: PRESIDENT
Credential: CP BOCP
Phone: 910-350-0067