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General NPI Number Information
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NPI Number | 1770577660
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Entity Type | Organization
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Legal Business Name | ACTIVMEDICAL DENTON, INC
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Dates
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Enumeration Date | 09/07/2005
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Last Update Date | 04/11/2019
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Provider Practice Location Address
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Address Line | 2317 W UNIVERSITY DR SUITE 101
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City | DENTON
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State | TX
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Zip | 76201-1600
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Country | US
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Telephone | 940-484-0228
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Fax | 940-484-0766
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Provider Business Mailing Address
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Address Line | 2317 W UNIVERSITY DR SUITE 101
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City | DENTON
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State | TX
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Zip | 76201-1600
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Country | US
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Telephone | 940-484-0228
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Fax | 940-484-0766
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES BEALL GARNER
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Credential |
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Telephone | 940-484-0228
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 0030874
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | 0030874
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 0030874
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 0030874
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License Number State | TX
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