Provider Demographics
NPI:1477074797
Name:PROACTIVE MEDICAL CONSULTANTS LLC
Entity type:Organization
Organization Name:PROACTIVE MEDICAL CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:NUSSBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:866-603-5911
Mailing Address - Street 1:8759 STONEHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-1912
Mailing Address - Country:US
Mailing Address - Phone:410-465-7548
Mailing Address - Fax:410-465-8471
Practice Address - Street 1:8759 STONEHOUSE DR
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-1912
Practice Address - Country:US
Practice Address - Phone:410-465-7548
Practice Address - Fax:410-465-8471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management