Provider Demographics
NPI:1275767048
Name:PROGRESSIVE MEDICAL EQUIPMENT AND SUPPLIES
Entity Type:Organization
Organization Name:PROGRESSIVE MEDICAL EQUIPMENT AND SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LLEWELLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-592-2332
Mailing Address - Street 1:7013 MISSIONARY RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-6349
Mailing Address - Country:US
Mailing Address - Phone:910-590-2332
Mailing Address - Fax:910-590-2553
Practice Address - Street 1:300B BEAMAN ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2908
Practice Address - Country:US
Practice Address - Phone:910-590-2332
Practice Address - Fax:910-590-2532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-08
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8109498332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies