Provider Demographics
NPI:1619087731
Name:PROGRESSIVE MEDICAL INTENSIVISTS
Entity Type:Organization
Organization Name:PROGRESSIVE MEDICAL INTENSIVISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-456-9500
Mailing Address - Street 1:PO BOX 16537
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85011-6537
Mailing Address - Country:US
Mailing Address - Phone:480-456-9500
Mailing Address - Fax:480-820-7623
Practice Address - Street 1:1400 S DOBSON RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202
Practice Address - Country:US
Practice Address - Phone:480-456-9500
Practice Address - Fax:480-820-7623
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ74998Medicare ID - Type Unspecified