1982891917 NPI number — CGM PROGRESSIVE SERVICES LLC

Table of content: (NPI 1982891917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982891917 NPI number — CGM PROGRESSIVE SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CGM PROGRESSIVE SERVICES 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:
1982891917
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1305 E JUAREZ ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHARR
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78577-4316
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-702-3870
Provider Business Mailing Address Fax Number:
956-702-3875

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1305 E JUAREZ ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHARR
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78577-4316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-702-3870
Provider Business Practice Location Address Fax Number:
956-702-3875
Provider Enumeration Date:
10/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GUERRA
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
Y
Authorized Official Title or Position:
MANAGING MEMBER/ADMINISTRATOR
Authorized Official Telephone Number:
956-702-3870

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , with the licence number:  120132 , 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: TX-108-6084 . This is a "SPECIAL NUTRITION PROGRAM" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com