Provider Demographics
NPI:1659536951
Name:PROGRESSIVE IMAGING LLC
Entity Type:Organization
Organization Name:PROGRESSIVE IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:V
Authorized Official - Last Name:BONAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-210-0350
Mailing Address - Street 1:13641 METROPOLIS AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4433
Mailing Address - Country:US
Mailing Address - Phone:239-210-0350
Mailing Address - Fax:239-210-0353
Practice Address - Street 1:13641 METROPOLIS AVE.
Practice Address - Street 2:STE. 102
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4433
Practice Address - Country:US
Practice Address - Phone:239-210-0530
Practice Address - Fax:239-210-0353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-25
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLJR43749000261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology