=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699082032
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACT MEDICAL GROUP, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2010
-----------------------------------------------------
Last Update Date | 10/18/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23 ORANGE ST
-----------------------------------------------------
City | ASHEVILLE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28801-2328
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-239-0156
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 696
-----------------------------------------------------
City | HAMPSTEAD
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28443-0696
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-791-6767
-----------------------------------------------------
Fax | 910-791-6890
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ERINN M BEEKMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 910-791-6767
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 87550
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------