Organization Name: | ACTIVE MEDICAL CENTER LTD |
NPI Number: | 1821445180 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JEREMY JOSEPH DARNELL (PRESIDENT) |
Mailing Address: | 754 S 8th St West Dundee |
State: | IL US |
Postal Code: | 601182102 |
Phone Number: | 8478365202 |
Fax Number: | 8478365209 |
NPI Enumeration Date: | 05/17/2016 |
NPI Last Update Date: | 05/17/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |