Provider Demographics
NPI:1548413073
Name:ACTIVE ORTHOPEDIC BRACING, INC.
Entity Type:Organization
Organization Name:ACTIVE ORTHOPEDIC BRACING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHOTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BUCHHOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:256-534-8637
Mailing Address - Street 1:2745 BOB WALLACE AVE SW
Mailing Address - Street 2:STE D
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35805-4158
Mailing Address - Country:US
Mailing Address - Phone:256-534-8637
Mailing Address - Fax:256-704-0024
Practice Address - Street 1:2745 BOB WALLACE AVE SW
Practice Address - Street 2:STE D
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-4158
Practice Address - Country:US
Practice Address - Phone:256-534-8637
Practice Address - Fax:256-704-0024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6890332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1548413073Medicaid
AL6047390001Medicare NSC