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Organization

ACTIVE MEDICAL LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ROBERT JOSEPH TANT (MEMBER/MANAGER)
(304) 397-6599
Entity
Organization

Contact information

Practice address
1107 MAIN ST, MILTON, WV 25541-1271
(304) 397-6599
(304) 397-6566
Mailing address
1107 MAIN ST, MILTON, WV 25541-1271
(304) 397-6599
(304) 397-6566

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3910005780
WV
Enumeration date
07/11/2019
Last updated
07/11/2019
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