Provider Demographics
NPI:1194334342
Name:ACT MEDGROUP, LLC
Entity type:Organization
Organization Name:ACT MEDGROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-744-9053
Mailing Address - Street 1:PO BOX 2099
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-0019
Mailing Address - Country:US
Mailing Address - Phone:903-744-9053
Mailing Address - Fax:
Practice Address - Street 1:12325 HUDSON DR
Practice Address - Street 2:
Practice Address - City:ALVARADO
Practice Address - State:TX
Practice Address - Zip Code:76009-6132
Practice Address - Country:US
Practice Address - Phone:903-744-9053
Practice Address - Fax:940-427-7189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies