Provider Demographics
NPI:1770625857
Name:ACTIVE FEET, INC.
Entity type:Organization
Organization Name:ACTIVE FEET, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:A
Authorized Official - Last Name:REINGOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:858-792-1142
Mailing Address - Street 1:550 LOMAS SANTA FE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-1343
Mailing Address - Country:US
Mailing Address - Phone:858-792-1142
Mailing Address - Fax:858-755-6785
Practice Address - Street 1:4545 LA JOLLA VILLAGE DR
Practice Address - Street 2:#9026
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-1241
Practice Address - Country:US
Practice Address - Phone:858-453-5057
Practice Address - Fax:858-453-5058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5169550001Medicare NSC