Provider Demographics
NPI:1609877729
Name:PROGRESSIVE HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:PROGRESSIVE HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:DAVEZAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-654-1560
Mailing Address - Street 1:PO BOX 1339
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-1339
Mailing Address - Country:US
Mailing Address - Phone:225-654-1560
Mailing Address - Fax:225-654-9574
Practice Address - Street 1:12038 GREENWELL SPRINGS PORT HUDSON RD
Practice Address - Street 2:
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791
Practice Address - Country:US
Practice Address - Phone:225-654-1560
Practice Address - Fax:225-654-9574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1900606052OtherBLUE CROSS BLUE SHIELD
LA1900606052OtherBLUE CROSS BLUE SHIELD