Provider Demographics
NPI:1790833465
Name:ACTIVE MEDICAL SUPPLIES, INC
Entity Type:Organization
Organization Name:ACTIVE MEDICAL SUPPLIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LES
Authorized Official - Middle Name:
Authorized Official - Last Name:CHALFIN
Authorized Official - Suffix:
Authorized Official - Credentials:C-PED
Authorized Official - Phone:515-256-9006
Mailing Address - Street 1:2413 BUCKINGHAM SQ
Mailing Address - Street 2:#315
Mailing Address - City:URBANDALE
Mailing Address - State:IA
Mailing Address - Zip Code:50322-4522
Mailing Address - Country:US
Mailing Address - Phone:515-779-7702
Mailing Address - Fax:515-285-9247
Practice Address - Street 1:2413 BUCKINGHAM SQ
Practice Address - Street 2:#315
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50322-4522
Practice Address - Country:US
Practice Address - Phone:515-779-7702
Practice Address - Fax:515-285-9247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5853650001Medicare NSC