1457752032 NPI number — PROGRESSIVE PHARMA LLC

Table of content: (NPI 1457752032)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457752032 NPI number — PROGRESSIVE PHARMA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROGRESSIVE PHARMA LLC
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:
6
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:
1457752032
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5710 LBJ FWY
Provider Second Line Business Mailing Address:
SUITE 325
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75240-6324
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-432-6550
Provider Business Mailing Address Fax Number:
214-261-2217

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1535 WEST LOOP S
Provider Second Line Business Practice Location Address:
SUITE 322
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77027-9512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-432-6550
Provider Business Practice Location Address Fax Number:
214-261-2217
Provider Enumeration Date:
09/15/2014

Additional Information

Authorized Official

Authorized Official Last Name:
MORTAZAVI
Authorized Official First Name:
AMIR
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED OFFICAL
Authorized Official Telephone Number:
972-432-6550

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  29069 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2147410 . This is a "PK" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com