Provider Demographics
NPI:1245219799
Name:ACT MEDICAL GROUP PA
Entity Type:Organization
Organization Name:ACT MEDICAL GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERINN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BEEKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-791-6767
Mailing Address - Street 1:PO BOX 696
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443
Mailing Address - Country:US
Mailing Address - Phone:910-791-6767
Mailing Address - Fax:910-791-6890
Practice Address - Street 1:311-4E JUDGES RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3655
Practice Address - Country:US
Practice Address - Phone:910-791-6767
Practice Address - Fax:910-791-6890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-12
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC87550174400000X
208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC016UGOtherBCBSNC PRIMARY CARE ONLY
NC0706GOtherBCBSNC MENTAL HEALTH ONLY
NC890706GMedicaid
NC6005401Medicaid
NCCI3714OtherRAILROAD MEDICARE
NC20992OtherPIEDMONT BEHAVIORAL HEALT
NCE698OtherPARTNERS
NCCI3714OtherRAILROAD MEDICARE
NCE698OtherPARTNERS
NC2800233Medicare PIN