Provider Demographics
NPI:1508989484
Name:LETAPCO-PROGRESSIVE HOME MEDICAL
Entity Type:Organization
Organization Name:LETAPCO-PROGRESSIVE HOME MEDICAL
Other - Org Name:PROGRESSIVE HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRIT
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:480-895-1877
Mailing Address - Street 1:10450 E RIGGS RD
Mailing Address - Street 2:SUITE #107
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-7758
Mailing Address - Country:US
Mailing Address - Phone:480-895-1877
Mailing Address - Fax:480-895-2949
Practice Address - Street 1:10450 E RIGGS RD
Practice Address - Street 2:SUITE #107
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-7758
Practice Address - Country:US
Practice Address - Phone:480-895-1877
Practice Address - Fax:480-895-2949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-07
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BP3500X, 332BX2000X
AZ20983336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ2098OtherPHARMACY LICENCE NUMBER
AZAZ0278050OtherBCBS OF ARIZONA
AZ0316883OtherNABP NUMBER
AZAZ0278050OtherBCBS OF ARIZONA
AZ0367430001Medicare NSC