| Organization Name: | ACTIVE HEALTHCARE OF NELSONVILLE LLC |
| NPI Number: | 1255682761 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TERESA ANN HINE (OFFICE MANAGER) |
| Mailing Address: | 1259 E Canal St Nelsonville |
| State: | OH US |
| Postal Code: | 457648000 |
| Phone Number: | 7407531902 |
| Fax Number: | 7407534233 |
| NPI Enumeration Date: | 09/24/2012 |
| NPI Last Update Date: | 01/22/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |