Provider Demographics
NPI:1770577660
Name:ACTIVMEDICAL DENTON, INC
Entity type:Organization
Organization Name:ACTIVMEDICAL DENTON, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BEALL
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-484-0228
Mailing Address - Street 1:2317 W UNIVERSITY DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-1600
Mailing Address - Country:US
Mailing Address - Phone:940-484-0228
Mailing Address - Fax:940-484-0766
Practice Address - Street 1:2317 W UNIVERSITY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-1600
Practice Address - Country:US
Practice Address - Phone:940-484-0228
Practice Address - Fax:940-484-0766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2019-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0030874332BC3200X, 332BP3500X, 332BX2000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX108415401Medicaid
TX079217801Medicaid
TX517284OtherHMO BLUE ORTHO AND PROS
TX10007096OtherAMERIGROUP
TX0136319-01Medicaid
TX505306OtherBCBS
TX0333820001Medicare NSC