Provider Demographics
NPI:1467635532
Name:PROGRESSIVE ORTHOPAEDICS, INC
Entity Type:Organization
Organization Name:PROGRESSIVE ORTHOPAEDICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PROGRESSIVE ORTHOPAEDICS,
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-670-8020
Mailing Address - Street 1:150 SPRINGSIDE DR
Mailing Address - Street 2:SUITE C320
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-2468
Mailing Address - Country:US
Mailing Address - Phone:330-670-8020
Mailing Address - Fax:330-670-8045
Practice Address - Street 1:150 SPRINGSIDE DR
Practice Address - Street 2:SUITE C320
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-2468
Practice Address - Country:US
Practice Address - Phone:330-670-8020
Practice Address - Fax:330-670-8045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35045740207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0634728Medicaid
OHA82409Medicare UPIN
OH0325880001Medicare NSC
OH9268551Medicare PIN