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General NPI Number Information
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NPI Number | 1578157178
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Entity Type | Organization
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Legal Business Name | ACTIVE MEDICAL LLC
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Dates
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Enumeration Date | 02/24/2021
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Last Update Date | 02/24/2021
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Provider Practice Location Address
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Address Line | 89 HICKORY DR
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City | BECKLEY
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State | WV
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Zip | 25801-2834
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Country | US
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Telephone | 304-763-7029
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Fax | 304-619-5302
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Provider Business Mailing Address
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Address Line | 3890 TEAYS VALLEY RD
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City | HURRICANE
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State | WV
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Zip | 25526-9720
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Country | US
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Telephone | 304-397-6599
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Fax | 304-397-6566
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Authorized Official
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Title or Position | MEMBER/MANAGER
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Name | ROBERT JOSEPH TANT
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Credential |
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Telephone | 304-389-1246
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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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