Provider Demographics
NPI:1841776705
Name:PROGRESSIVE ORTHOTIC & PROSTHETIC SERVICES, INC
Entity Type:Organization
Organization Name:PROGRESSIVE ORTHOTIC & PROSTHETIC SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:ARNETTE
Authorized Official - Suffix:
Authorized Official - Credentials:CPO
Authorized Official - Phone:918-663-7077
Mailing Address - Street 1:9511 E 46TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-7201
Mailing Address - Country:US
Mailing Address - Phone:918-663-7077
Mailing Address - Fax:
Practice Address - Street 1:10 E 6TH ST.
Practice Address - Street 2:
Practice Address - City:GROVE
Practice Address - State:OK
Practice Address - Zip Code:74344
Practice Address - Country:US
Practice Address - Phone:918-786-7701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-13
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLPO5335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100791610AMedicaid