Provider Demographics
NPI:1457624041
Name:ACTIVMED PRACTICES & RESEARCH, INC.
Entity Type:Organization
Organization Name:ACTIVMED PRACTICES & RESEARCH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MA, CCRC, CEO
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:STUBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-319-8863
Mailing Address - Street 1:421 MERRIMACK STREET
Mailing Address - Street 2:SUITE 203
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-5864
Mailing Address - Country:US
Mailing Address - Phone:978-655-7155
Mailing Address - Fax:978-655-7144
Practice Address - Street 1:421 MERRIMACK ST
Practice Address - Street 2:SUITE 203
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5864
Practice Address - Country:US
Practice Address - Phone:978-655-7155
Practice Address - Fax:978-655-7144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-14
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch