Provider Demographics
NPI:1245539592
Name:PROGRESSIVE HEALTH ORTHOPEDIC MEDICAL GROUP, INC
Entity type:Organization
Organization Name:PROGRESSIVE HEALTH ORTHOPEDIC MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-775-1400
Mailing Address - Street 1:81880 DR CARREON BLVD
Mailing Address - Street 2:SUITE B209
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5559
Mailing Address - Country:US
Mailing Address - Phone:760-775-1400
Mailing Address - Fax:760-775-1401
Practice Address - Street 1:81880 DR CARREON BLVD
Practice Address - Street 2:SUITE B209
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5559
Practice Address - Country:US
Practice Address - Phone:760-775-1400
Practice Address - Fax:760-775-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43101207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty