1316991011 NPI number — PROGRESSIVE MEDICAL CLINIC, LLP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316991011 NPI number — PROGRESSIVE MEDICAL CLINIC, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROGRESSIVE MEDICAL CLINIC, LLP
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:
1316991011
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11920 ASTORIA BLVD
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77089-6043
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-481-8878
Provider Business Mailing Address Fax Number:
281-481-9020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11920 ASTORIA BLVD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77089-6043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-481-8878
Provider Business Practice Location Address Fax Number:
281-481-9020
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WARNEKE
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
LARRY
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
281-481-8878

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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