Provider Demographics
NPI:1659596328
Name:PROGRESSIVEHEALTH OF INDIANA, LLC
Entity Type:Organization
Organization Name:PROGRESSIVEHEALTH OF INDIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:R
Authorized Official - Last Name:BERSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-491-3856
Mailing Address - Street 1:150 N ROSENBERGER AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47712-6503
Mailing Address - Country:US
Mailing Address - Phone:812-491-3856
Mailing Address - Fax:812-491-1269
Practice Address - Street 1:4521 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0654
Practice Address - Country:US
Practice Address - Phone:812-477-3422
Practice Address - Fax:812-475-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200873150BMedicaid
IN156633Medicare PIN
IN156633Medicare PIN
IN200873150BMedicaid
IN200873150DMedicaid
156633Medicare Oscar/Certification