Provider Demographics
NPI:1386940062
Name:AXOGEN CORPORATION
Entity type:Organization
Organization Name:AXOGEN CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ZADEREJ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-462-6818
Mailing Address - Street 1:13859 PROGRESS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615-9403
Mailing Address - Country:US
Mailing Address - Phone:386-462-6800
Mailing Address - Fax:352-462-6801
Practice Address - Street 1:13859 PROGRESS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615-9403
Practice Address - Country:US
Practice Address - Phone:386-462-6800
Practice Address - Fax:352-462-6801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-28
Last Update Date:2011-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site