Active Health Medical Center, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

Legal business name

ACTIVE HEALTH MEDICAL CENTER, LLC

Practice address

12144 US Highway 301 N Unit 101
Parrish, FL 34219-1134

Phone

(332) 286-5417

Fax

(870) 888-0627

NPI assigned

Sep 24, 2026

Last updated

Oct 8, 2026By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tracy R. Goldberg

Title

Director

Phone

(332) 286-5417

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1790208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1791417600000",
    "number": "1215840806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1913 S MINTLE ST TRLR 42",
            "city": "AIRWAY HEIGHTS",
            "state": "WA",
            "postal_code": "990015262",
            "fax_number": "870-888-0627"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12144 US HIGHWAY 301 N UNIT 101",
            "city": "PARRISH",
            "state": "FL",
            "postal_code": "342191134",
            "telephone_number": "332-286-5417",
            "fax_number": "870-888-0627"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1913 S Mintle St",
            "address_purpose": "LOCATION",
            "city": "Airway Heights",
            "state": "WA",
            "postal_code": "990015168",
            "country_code": "US",
            "telephone_number": "870-888-0627",
            "fax_number": "870-888-0627",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ACTIVE HEALTH MEDICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-09-24",
        "last_updated": "2026-10-08",
        "certification_date": "2026-10-08",
        "status": "A",
        "authorized_official_last_name": "GOLDBERG",
        "authorized_official_first_name": "TRACY R.",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "332-286-5417"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.