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General NPI Number Information
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NPI Number | 1386940062
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Entity Type | Organization
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Legal Business Name | AXOGEN CORPORATION
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Dates
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Enumeration Date | 01/28/2011
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Last Update Date | 01/28/2011
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Provider Practice Location Address
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Address Line | 13859 PROGRESS BLVD STE 100
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City | ALACHUA
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State | FL
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Zip | 32615-9403
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Country | US
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Telephone | 386-462-6800
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Fax | 352-462-6801
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Provider Business Mailing Address
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Address Line | 13859 PROGRESS BLVD STE 100
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City | ALACHUA
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State | FL
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Zip | 32615-9403
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Country | US
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Telephone | 386-462-6800
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Fax | 352-462-6801
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MRS. KAREN L ZADEREJ
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Credential |
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Telephone | 386-462-6818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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