ACTIVE LIFESTYLE MEDICAL, LLC
NPI 1902370885
Durable Medical Equipment & Medical Supplies in Tulsa, OK

Active since January 14, 2019
5455 S MINGO RD STE E, TULSA, OK 74146(918) 576-6765(888) 605-4113 Get Directions Write a Review

NPPES record last updated: May 18, 2022. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Active Lifestyle Medical, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ACTIVE LIFESTYLE MEDICAL, LLC (NPI 1902370885) is a healthcare organization registered as a durable medical equipment & medical supplies in Tulsa, Oklahoma and active in the NPI registry since January 2019. The organization maintains a secondary practice location in Tulsa and lists Robbie L. Ely, President, as its authorized official.

NPPES Registry Identity

NPI1902370885
Entity TypeOrganization
Primary Taxonomy332B00000X
Legal Business NameACTIVE LIFESTYLE MEDICAL, LLC
Location Address5455 S MINGO RD STE ETulsa, OK 74146-5724
Mailing Address5455 S Mingo Rd Ste ETulsa, OK 74146-5724 · (918) 576-6765 · Fax (888) 605-4113
Fax(888) 605-4113
Organization SubpartNo
Authorized OfficialRobbie L. ElyPresident · (918) 520-8008
Enumeration DateJanuary 14, 2019
Last NPPES UpdateMay 18, 2022
NPPES CertifiedMay 18, 2022
NPI 1902370885 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyDurable Medical Equipment & Medical SuppliesSuppliers
Taxonomy Code332B00000X
Definition

A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

5455 S MINGO RD STE E, Tulsa, OK 74146

Secondary Practice Location 1

Location 18740 E 11th St Ste DTulsa, OK 74112-7957 · Phone (918) 520-8008 · Fax (918) 928-4458

Other Identifiers 6

OtherO20190822002462OK · Managed Plans
MedicaidO20190822002462MO
MedicaidO20190822002462OK
OtherO20190822002462KS · Managed Plans
OtherO20190822002462MO · Managed Plans
MedicaidO20190822002462KS

Medical Equipment Supplier Medicare DMEPOS 4

Medicare supplier enrollment and the product categories Active Lifestyle Medical carries, from the Medicare DMEPOS supplier directory.

Active Lifestyle Medical

DMEPOS supplier · Tulsa, OKOperated by Active Lifestyle Medical, LLC

Accepts Medicare assignment

Active Lifestyle Medical agrees to accept the Medicare-approved amount as full payment for covered equipment and supplies. Medicare patients are not billed beyond the standard deductible and coinsurance.

PTAN (Medicare Supplier Number)20420111
Medicare Participant SinceAugust 22, 2019
Supplier Location5455 S Mingo Rd Ste ETulsa, OK 74146
Provider TypeMedical Supply Company With Pedorthic Personnel

Medicare Product Categories

Orthoses: Prefabricated (Non-Custom Fabricated)
Met pads, Heel pads, Heel spur pads
Orthoses: Off-The-Shelf
Met pads, Heel pads, Heel spur pads
Diabetic Shoes and Inserts
Shoes, Socks, Insoles
Diabetic Shoes/Inserts - Custom
Custom fabricated shoes, socks, & insoles
Product categories are from the Medicare DMEPOS supplier directory. Contact the supplier to confirm current availability of specific items.

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1902370885, enumerated as an "organization" on January 14, 2019.

The provider is located at 5455 S MINGO RD STE E TULSA, OK 74146 and the phone number is (918) 576-6765.

Durable Medical Equipment & Medical Supplies with taxonomy code 332B00000X.

The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.