Provider Demographics
NPI:1336328434
Name:ACTIVE MOBILITY, INC.
Entity Type:Organization
Organization Name:ACTIVE MOBILITY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ATKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-776-0005
Mailing Address - Street 1:2374 JEFFERSON HWY
Mailing Address - Street 2:SUITE 108
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-6503
Mailing Address - Country:US
Mailing Address - Phone:540-942-9600
Mailing Address - Fax:540-942-9700
Practice Address - Street 1:2374 JEFFERSON HWY
Practice Address - Street 2:SUITE 108
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-6503
Practice Address - Country:US
Practice Address - Phone:540-942-9600
Practice Address - Fax:540-942-9700
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACTIVE MOBILITY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-25
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010157480Medicaid
VA010157480Medicaid
VA5427652221Medicare PIN