Provider Demographics
NPI:1760848691
Name:ACTIVE MEDICAL AND MOBILITY INC.
Entity Type:Organization
Organization Name:ACTIVE MEDICAL AND MOBILITY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-944-3642
Mailing Address - Street 1:409 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-2062
Mailing Address - Country:US
Mailing Address - Phone:888-316-9145
Mailing Address - Fax:866-430-7946
Practice Address - Street 1:409 MAIN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-2062
Practice Address - Country:US
Practice Address - Phone:888-316-9145
Practice Address - Fax:866-430-7946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-07
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier