Provider Demographics
NPI:1558883348
Name:WOMEN'S PROGRESSIVE GROUP INC
Entity Type:Organization
Organization Name:WOMEN'S PROGRESSIVE GROUP INC
Other - Org Name:WOMENS PROGRESSIVE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JESULA
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGCHAMP
Authorized Official - Suffix:
Authorized Official - Credentials:DOULAS
Authorized Official - Phone:214-853-1950
Mailing Address - Street 1:705 CHICKASAW TRCE
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-2916
Mailing Address - Country:US
Mailing Address - Phone:214-853-1950
Mailing Address - Fax:
Practice Address - Street 1:705 CHICKASAW TRCE
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-2916
Practice Address - Country:US
Practice Address - Phone:214-853-1950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-12
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175M00000X, 246ZC0007X, 251J00000X, 335E00000X, 374J00000X
NY374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty
No175M00000XOther Service ProvidersMidwife, LayGroup - Multi-Specialty
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty
No251J00000XAgenciesNursing Care
Yes335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty