Provider Demographics
NPI:1134316912
Name:PROGRESSIVE ORTHOTIC & PROSTHETIC SERVICES, INC
Entity Type:Organization
Organization Name:PROGRESSIVE ORTHOTIC & PROSTHETIC SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-786-7701
Mailing Address - Street 1:PO BOX 452007
Mailing Address - Street 2:
Mailing Address - City:GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74345-2007
Mailing Address - Country:US
Mailing Address - Phone:918-786-7701
Mailing Address - Fax:918-786-7708
Practice Address - Street 1:1631 SE WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-4933
Practice Address - Country:US
Practice Address - Phone:918-786-7701
Practice Address - Fax:918-786-7708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier