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General NPI Number Information
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NPI Number | 1588676233
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Entity Type | Organization
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Legal Business Name | ACTIVA MEDICAL SUPPLIES INC
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 07/06/2009
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Provider Practice Location Address
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Address Line | 2212 W NORTH AVE
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City | CHICAGO
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State | IL
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Zip | 60647-8467
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Country | US
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Telephone | 312-266-6160
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Fax |
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Provider Business Mailing Address
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Address Line | 1901 N MOHAWK ST
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City | CHICAGO
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State | IL
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Zip | 60614-5219
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Country | US
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Telephone | 312-266-6160
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MARIA SMEKHOV
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Credential |
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Telephone | 312-266-6160
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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 | 203000704
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License Number State | IL
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