Provider Demographics
NPI:1508363482
Name:PROGRESSIVE ORTHOTIC & PROSTHETIC SERVICES, INC
Entity Type:Organization
Organization Name:PROGRESSIVE ORTHOTIC & PROSTHETIC SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-663-7077
Mailing Address - Street 1:9511 E 46TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-7201
Mailing Address - Country:US
Mailing Address - Phone:918-663-7077
Mailing Address - Fax:
Practice Address - Street 1:2121 S COLUMBIA AVE STE LL8
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-3512
Practice Address - Country:US
Practice Address - Phone:918-663-1166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-09
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier