MEDICARE: ACTIVE MOBILITY, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)		VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902961568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTIVE MOBILITY, INC

Provider Business Mailing Address
First Line	:	5508 FORT AVE STE A
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-5326
Country	:	US
Telephone Number	:	434-237-8004
Fax Number	:	434-237-8005

Provider Business Practice Location Address
First Line	:	5508 FORT AVE STE A
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24502-5326
Country	:	US
Telephone Number	:	434-237-8004
Fax Number	:	434-237-8005

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MELVIN DWIGHT ATKINSON
Credential	:
Telephone Number	:	434-237-8004

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	07/21/2022

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