Provider Demographics
NPI:1043574361
Name:AXIS CARE
Entity Type:Organization
Organization Name:AXIS CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:ELLISON
Authorized Official - Last Name:PUSSER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:828-378-0060
Mailing Address - Street 1:PO BOX 1974
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28802-1974
Mailing Address - Country:US
Mailing Address - Phone:828-378-0060
Mailing Address - Fax:
Practice Address - Street 1:250 POTATO BRANCH RD
Practice Address - Street 2:
Practice Address - City:LEICESTER
Practice Address - State:NC
Practice Address - Zip Code:28748-6606
Practice Address - Country:US
Practice Address - Phone:828-378-0060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-02
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400401207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCB476OtherMEDICARE PTAN