Provider Demographics
NPI:1679036313
Name:PROGRESSIVE MEDICAL MANAGEMENT OF BATESVILLE LLC
Entity Type:Organization
Organization Name:PROGRESSIVE MEDICAL MANAGEMENT OF BATESVILLE LLC
Other - Org Name:PANOLA MEDICAL CENTER WEST CAMPUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD VICE CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-212-3505
Mailing Address - Street 1:303 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606-8608
Mailing Address - Country:US
Mailing Address - Phone:985-502-6153
Mailing Address - Fax:
Practice Address - Street 1:155 KEATING RD
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-2901
Practice Address - Country:US
Practice Address - Phone:662-561-4075
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROGRESSIVE MEDICAL MANAGEMENT OF BATESVILLE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-10
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit