Provider Demographics
NPI:1376771295
Name:PROGRESSIVE PEDIATRICS - BEEBE, INC
Entity Type:Organization
Organization Name:PROGRESSIVE PEDIATRICS - BEEBE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDRUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-258-7944
Mailing Address - Street 1:807 KAMAK DR
Mailing Address - Street 2:
Mailing Address - City:BEEBE
Mailing Address - State:AR
Mailing Address - Zip Code:72012-2087
Mailing Address - Country:US
Mailing Address - Phone:501-258-7944
Mailing Address - Fax:
Practice Address - Street 1:27 HWY 64 W
Practice Address - Street 2:SUITE 3
Practice Address - City:BEEBE
Practice Address - State:AR
Practice Address - Zip Code:72012-2094
Practice Address - Country:US
Practice Address - Phone:501-882-6660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty