Active Living Store Inc.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

1626 Issued in FL

Legal business name

ACTIVE LIVING STORE INC.

Practice address

17860 SE 109TH Ave
#630
Summerfield, FL 34491-8911

Phone

(352) 307-3511

Fax

(352) 307-1151

NPI assigned

Feb 7, 2007

Last updated

Aug 22, 2020By 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

Mr. Page R. Whittle

Title

Vice President

Phone

(352) 307-3511

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1871633073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 492936",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347492936",
            "telephone_number": "352-307-3511",
            "fax_number": "352-307-1151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17860 SE 109TH AVE",
            "address_2": "#630",
            "city": "SUMMERFIELD",
            "state": "FL",
            "postal_code": "344918911",
            "telephone_number": "352-307-3511",
            "fax_number": "352-307-1151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE LIVING STORE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WHITTLE",
        "authorized_official_first_name": "PAGE",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "352-307-3511",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "FL",
            "license": "1626",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Summerfield, FL
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.