Provider Demographics
NPI:1902961568
Name:ACTIVE MOBILITY, INC
Entity Type:Organization
Organization Name:ACTIVE MOBILITY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:DWIGHT
Authorized Official - Last Name:ATKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-237-8004
Mailing Address - Street 1:5508 FORT AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-5326
Mailing Address - Country:US
Mailing Address - Phone:434-237-8004
Mailing Address - Fax:434-237-8005
Practice Address - Street 1:5508 FORT AVE STE A
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-5326
Practice Address - Country:US
Practice Address - Phone:434-237-8004
Practice Address - Fax:434-237-8005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010157480Medicaid
VA010157480Medicaid