Provider Demographics
NPI:1164400552
Name:PROGRESSIVE PROSTHETIC & ORTHOPEDIC SERVICES, INC.
Entity Type:Organization
Organization Name:PROGRESSIVE PROSTHETIC & ORTHOPEDIC SERVICES, INC.
Other - Org Name:PROGRESSIVE PROSTHETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHIAS
Authorized Official - Middle Name:JESSE
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:757-456-5501
Mailing Address - Street 1:380 CLEVELAND PL
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-6529
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:757-671-7525
Practice Address - Street 1:1577 WILROY RD
Practice Address - Street 2:STE 300
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-2435
Practice Address - Country:US
Practice Address - Phone:757-538-2074
Practice Address - Fax:757-671-7525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0348840002Medicare NSC