Provider Demographics
NPI:1285932186
Name:ACTIVE MEDICAL LLC
Entity type:Organization
Organization Name:ACTIVE MEDICAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TANNER
Authorized Official - Middle Name:E
Authorized Official - Last Name:CROPPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-292-0412
Mailing Address - Street 1:135 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-2726
Mailing Address - Country:US
Mailing Address - Phone:541-899-2077
Mailing Address - Fax:541-899-1795
Practice Address - Street 1:135 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97501-2726
Practice Address - Country:US
Practice Address - Phone:541-899-2077
Practice Address - Fax:541-899-1795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies