MEDICARE: ACTIVSTYLE, 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	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
2	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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902194889
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTIVSTYLE, LLC

Provider Business Mailing Address
First Line	:	1055 WESTGATE DR STE 100
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1451
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2615 E END BLVD S
Second Line	:	SUITE 235
City	:	MARSHALL
State	:	TX
Zip	:	75672-7425
Country	:	US
Telephone Number	:	903-923-7010
Fax Number	:	903-923-7011

Authorized Official
Title or Position	:	CEO
Name	:	DARRELL DOUGLAS RAWLINGS
Credential	:
Telephone Number	:	612-895-7815

Provider Enumeration Date	:	07/13/2011
Last Update Date	:	10/31/2025

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Directions to “ACTIVSTYLE, LLC ” Practice Location

Language	Start Address	Practice Location

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