Provider Demographics
NPI:1902445380
Name:ACTIVE INTEGRATED MEDICAL CENTERS PC
Entity Type:Organization
Organization Name:ACTIVE INTEGRATED MEDICAL CENTERS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:DURR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-518-3370
Mailing Address - Street 1:797 E LANCASTER AVE STE 7
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-3360
Mailing Address - Country:US
Mailing Address - Phone:610-518-3370
Mailing Address - Fax:
Practice Address - Street 1:797 E LANCASTER AVE STE 7
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-3360
Practice Address - Country:US
Practice Address - Phone:610-518-3370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-02
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty