Provider Demographics
NPI:1982843629
Name:PROGRESSIVE MEDICAL REFERAL SERVICES
Entity Type:Organization
Organization Name:PROGRESSIVE MEDICAL REFERAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C E O
Authorized Official - Prefix:MS
Authorized Official - First Name:AVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-784-2227
Mailing Address - Street 1:7457 HARWIN DR STE 101
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-2025
Mailing Address - Country:US
Mailing Address - Phone:713-784-2227
Mailing Address - Fax:713-784-2295
Practice Address - Street 1:7457 HARWIN DR STE 101
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-2025
Practice Address - Country:US
Practice Address - Phone:713-784-2227
Practice Address - Fax:713-784-2295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20090027365305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service