Provider Demographics
NPI:1437215431
Name:PROGRESSIVE MEDICAL SPECIALISTS, INC
Entity Type:Organization
Organization Name:PROGRESSIVE MEDICAL SPECIALISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROJECT DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNAMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-873-5655
Mailing Address - Street 1:2453 W PIKE RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:PA
Mailing Address - Zip Code:15342
Mailing Address - Country:US
Mailing Address - Phone:724-873-5655
Mailing Address - Fax:724-873-5656
Practice Address - Street 1:2453 W PIKE RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:PA
Practice Address - Zip Code:15342
Practice Address - Country:US
Practice Address - Phone:724-873-5655
Practice Address - Fax:724-873-5656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA637025261QM2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2800XAmbulatory Health Care FacilitiesClinic/CenterMethadone
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01734010Medicaid
329976OtherVALUE OPTIONS