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General NPI Number Information
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NPI Number | 1043574361
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Entity Type | Organization
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Legal Business Name | AXIS CARE
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Dates
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Enumeration Date | 07/02/2012
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Last Update Date | 10/09/2012
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Provider Practice Location Address
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Address Line | 250 POTATO BRANCH RD
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City | LEICESTER
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State | NC
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Zip | 28748-6606
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Country | US
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Telephone | 828-378-0060
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1974
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City | ASHEVILLE
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State | NC
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Zip | 28802-1974
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Country | US
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Telephone | 828-378-0060
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. BENJAMIN ELLISON PUSSER
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Credential | D.O.
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Telephone | 828-378-0060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 200400401
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License Number State | NC
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