Provider Demographics
NPI:1639225261
Name:PROGRESSIVE MEDICAL
Entity Type:Organization
Organization Name:PROGRESSIVE MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KENT
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:760-448-4448
Mailing Address - Street 1:2720 LOKER AVE W
Mailing Address - Street 2:SUITE P
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010-6604
Mailing Address - Country:US
Mailing Address - Phone:760-448-4448
Mailing Address - Fax:760-448-4449
Practice Address - Street 1:2720 LOKER AVE W
Practice Address - Street 2:SUITE P
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92010-6604
Practice Address - Country:US
Practice Address - Phone:760-448-4448
Practice Address - Fax:760-448-4449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43639332B00000X, 332BC3200X, 332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME00536FMedicaid
CA0195170001Medicare NSC