1992329122 NPI number — PROGRESSIVE MEDICAL MANAGEMENT OF BATESVILLE LLC

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 1992329122 NPI number — PROGRESSIVE MEDICAL MANAGEMENT OF BATESVILLE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PROGRESSIVE MEDICAL MANAGEMENT OF BATESVILLE 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:
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:
1992329122
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
303 MEDICAL CENTER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BATESVILLE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38606-8608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-563-5611
Provider Business Mailing Address Fax Number:
662-563-0155

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
223 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SENATOBIA
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38668-2123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-562-4166
Provider Business Practice Location Address Fax Number:
662-562-4355
Provider Enumeration Date:
06/03/2020

Additional Information

Authorized Official

Authorized Official Last Name:
WHITWELL
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
QUENTIN
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
662-562-4166

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com