1205163110 NPI number — ACTIVE MEDICAL EQUIPMENT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205163110 NPI number — ACTIVE MEDICAL EQUIPMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACTIVE MEDICAL EQUIPMENT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205163110
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6356 ODESSA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST BLOOMFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48324-1360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-895-3978
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
28003 CENTER OAKS COURT
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
WIXOM
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48393-3345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-895-3978
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/13/2009

Additional Information

Authorized Official

Authorized Official Last Name:
IVERSON
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
248-895-3978

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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