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General NPI Number Information
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NPI Number | 1215840806
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Entity Type | Organization
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Legal Business Name | ACTIVE HEALTH MEDICAL CENTER, LLC
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Dates
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Enumeration Date | 09/24/2026
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Last Update Date | 09/24/2026
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Provider Practice Location Address
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Address Line | 12144 US HIGHWAY 301 N UNIT 101
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City | PARRISH
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State | FL
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Zip | 34219-1134
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Country | US
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Telephone | 332-286-5417
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 682
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City | AIRWAY HEIGHTS
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State | WA
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Zip | 99001-0682
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | TRACY R. GOLDBERG
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Credential |
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Telephone | 332-286-5417
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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