Provider Demographics
NPI:1437834256
Name:PROGRESS WEIGHT MANAGEMENT PLLC
Entity Type:Organization
Organization Name:PROGRESS WEIGHT MANAGEMENT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CODY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:701-388-3785
Mailing Address - Street 1:3625 LINCOLN ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7765
Mailing Address - Country:US
Mailing Address - Phone:701-388-3785
Mailing Address - Fax:
Practice Address - Street 1:3625 LINCOLN ST S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7765
Practice Address - Country:US
Practice Address - Phone:701-388-3785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-19
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Single Specialty