MEDICARE: ACTIVE MEDICAL LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750884292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTIVE MEDICAL LLC

Provider Business Mailing Address
First Line	:	120 PROSPEROUS PL STE 103
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-1866
Country	:	US
Telephone Number	:	859-421-1195
Fax Number	:	855-859-0123

Provider Business Practice Location Address
First Line	:	120 PROSPEROUS PL STE 103
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-1866
Country	:	US
Telephone Number	:	859-421-1195
Fax Number	:	855-859-0123

Authorized Official
Title or Position	:	OWNER
Name	:	JOSHUA HILL
Credential	:	DPM
Telephone Number	:	859-421-1195

Provider Enumeration Date	:	03/12/2018
Last Update Date	:	05/25/2021

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Directions to “ACTIVE MEDICAL LLC ” Practice Location

Language	Start Address	Practice Location

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