Provider Demographics
NPI:1376076059
Name:ULTRAMED GROUP, INC
Entity Type:Organization
Organization Name:ULTRAMED GROUP, INC
Other - Org Name:ACTIVE LIFESTYLE MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:N
Authorized Official - Last Name:ARNDT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-444-4141
Mailing Address - Street 1:20 PIDGEON HILL DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-6154
Mailing Address - Country:US
Mailing Address - Phone:703-444-4141
Mailing Address - Fax:
Practice Address - Street 1:20 PIDGEON HILL DR
Practice Address - Street 2:SUITE 102
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-6154
Practice Address - Country:US
Practice Address - Phone:703-444-4141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-10
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty