1912162496 NPI number — PROGRESSIVE DIAGNOSTICS INC

Table of content: (NPI 1912162496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912162496 NPI number — PROGRESSIVE DIAGNOSTICS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROGRESSIVE DIAGNOSTICS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912162496
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2646 W AUGUSTA BLVD UNIT 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60622-6594
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-946-4579
Provider Business Mailing Address Fax Number:
630-206-1591

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2646 W AUGUSTA BLVD UNIT 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60622-6594
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-946-4579
Provider Business Practice Location Address Fax Number:
630-904-8091
Provider Enumeration Date:
07/23/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DHINGRA
Authorized Official First Name:
KUMUD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
630-904-8091

Provider Taxonomy Codes

  • Taxonomy code: 246XS1301X , with the licence number:  3927-1129 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 246XS1301X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 76706 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 76700 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 76882 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 76536 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 76856 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 76872 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 76641 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".