Healthcare Provider Details

I. General information

NPI: 1699082032
Provider Name (Legal Business Name): ACT MEDICAL GROUP, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2010
Last Update Date: 10/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 ORANGE ST
ASHEVILLE NC
28801-2328
US

IV. Provider business mailing address

PO BOX 696
HAMPSTEAD NC
28443-0696
US

V. Phone/Fax

Practice location:
  • Phone: 828-239-0156
  • Fax:
Mailing address:
  • Phone: 910-791-6767
  • Fax: 910-791-6890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number87550
License Number StateNC

VIII. Authorized Official

Name: ERINN M BEEKMAN
Title or Position: PRESIDENT
Credential:
Phone: 910-791-6767