Provider Demographics
NPI:1225781255
Name:PROGRESSIVE MED SUPPLIES
Entity Type:Organization
Organization Name:PROGRESSIVE MED SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:YEMANE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLDEGABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-861-6800
Mailing Address - Street 1:1032 W FLORENCE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90044-2442
Mailing Address - Country:US
Mailing Address - Phone:323-861-6800
Mailing Address - Fax:
Practice Address - Street 1:1032 W FLORENCE AVE STE A
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90044-2442
Practice Address - Country:US
Practice Address - Phone:323-861-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies