MEDICARE: ACTIVE HEALTHCARE SUPPLIES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1265758965
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTIVE HEALTHCARE SUPPLIES, INC

Provider Business Mailing Address
First Line	:	944 LAKEVIEW DR
Second Line	:
City	:	HARBOR BEACH
State	:	MI
Zip	:	48441-8902
Country	:	US
Telephone Number	:	989-550-4035
Fax Number	:	989-550-4035

Provider Business Practice Location Address
First Line	:	1080 S VAN DYKE RD
Second Line	:	SUITE D
City	:	BAD AXE
State	:	MI
Zip	:	48413-9635
Country	:	US
Telephone Number	:	989-269-5400
Fax Number	:	989-269-5420

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ELIAS KABBAN
Credential	:
Telephone Number	:	989-550-4035

Provider Enumeration Date	:	04/20/2010
Last Update Date	:	12/08/2010

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