Provider Demographics
NPI:1275125056
Name:PROGRESSIVE MULTI MEDICAL SERVICES
Entity Type:Organization
Organization Name:PROGRESSIVE MULTI MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:OKWUCHI
Authorized Official - Last Name:UWANDU
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:443-931-5352
Mailing Address - Street 1:200 N PHILADELPHIA BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-2568
Mailing Address - Country:US
Mailing Address - Phone:443-530-3182
Mailing Address - Fax:443-399-8223
Practice Address - Street 1:200 N PHILADELPHIA BLVD STE A
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-2568
Practice Address - Country:US
Practice Address - Phone:443-530-3182
Practice Address - Fax:443-399-8223
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROGRESSIVE MULTI MEDICAL SERVICES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-03
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD817005300Medicaid