Healthcare Provider Details

I. General information

NPI: 1245219799
Provider Name (Legal Business Name): ACT MEDICAL GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 12/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311-4E JUDGES RD
WILMINGTON NC
28405-3655
US

IV. Provider business mailing address

PO BOX 696
HAMPSTEAD NC
28443
US

V. Phone/Fax

Practice location:
  • Phone: 910-791-6767
  • Fax: 910-791-6890
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
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

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