Provider Demographics
NPI:1659070522
Name:PROGRESSIVE SPECIALTY CENTERS LLC
Entity Type:Organization
Organization Name:PROGRESSIVE SPECIALTY CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-357-3883
Mailing Address - Street 1:979 HIGHWAY 6 W
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-9079
Mailing Address - Country:US
Mailing Address - Phone:727-488-1400
Mailing Address - Fax:
Practice Address - Street 1:979 HIGHWAY 6 W
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-9079
Practice Address - Country:US
Practice Address - Phone:727-488-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center