Provider Demographics
NPI:1124154463
Name:PROGRESSIVE DME AND MEDICAL SUPPLY
Entity type:Organization
Organization Name:PROGRESSIVE DME AND MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CANALIZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-263-1700
Mailing Address - Street 1:1141 WHITNEY AVE
Mailing Address - Street 2:BUILDING 4
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-5011
Mailing Address - Country:US
Mailing Address - Phone:504-263-1700
Mailing Address - Fax:504-263-1711
Practice Address - Street 1:1141 WHITNEY AVE
Practice Address - Street 2:BUILDING 4
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-5011
Practice Address - Country:US
Practice Address - Phone:504-263-1700
Practice Address - Fax:504-263-1711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1478717Medicaid
LA5240740001Medicare ID - Type Unspecified