Provider Demographics
NPI:1013644608
Name:ARLINGTON PROGRESSIVE HEALTH CENTER INC.
Entity Type:Organization
Organization Name:ARLINGTON PROGRESSIVE HEALTH CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ADEBAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:OLATUNJI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:682-597-5097
Mailing Address - Street 1:2600 MALL CIR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-1546
Mailing Address - Country:US
Mailing Address - Phone:817-870-1033
Mailing Address - Fax:
Practice Address - Street 1:306 E RANDOL MILL RD STE 136
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-5841
Practice Address - Country:US
Practice Address - Phone:682-597-5097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-03
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty