Provider Demographics
NPI:1831314046
Name:PROGRESSIVE HEALTH CARE FOR WOMEN, LTD
Entity Type:Organization
Organization Name:PROGRESSIVE HEALTH CARE FOR WOMEN, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:URSULA
Authorized Official - Middle Name:L
Authorized Official - Last Name:THATCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-288-0060
Mailing Address - Street 1:6810 S.R. 162
Mailing Address - Street 2:STE 100
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062
Mailing Address - Country:US
Mailing Address - Phone:618-288-0060
Mailing Address - Fax:618-288-0062
Practice Address - Street 1:6810 S.R. 162
Practice Address - Street 2:STE 100
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062
Practice Address - Country:US
Practice Address - Phone:618-288-0060
Practice Address - Fax:618-288-0062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO36980207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL060-10076OtherBCBS
IL=========OtherID
IL=========OtherID