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General NPI Number Information
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NPI Number | 1194440297
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Entity Type | Organization
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Legal Business Name | PROACTIVE MD CO, P.C.
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Dates
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Enumeration Date | 10/11/2022
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Last Update Date | 04/10/2025
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Provider Practice Location Address
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Address Line | 10485 SHERIDAN BLVD STE 200
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City | WESTMINSTER
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State | CO
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Zip | 80020-4108
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Country | US
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Telephone | 303-466-8344
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Fax |
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Provider Business Mailing Address
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Address Line | 124 ALLAWOOD CT
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-6207
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Country | US
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Telephone | 864-501-0751
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Fax |
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Authorized Official
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Title or Position | CMO
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Name | MARK KEMBLE
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Credential | MD
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Telephone | 864-501-0751
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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