Provider Demographics
NPI:1255375564
Name:PROGRESSIVE MEDICAL SUPPLY, INC.
Entity type:Organization
Organization Name:PROGRESSIVE MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-319-6710
Mailing Address - Street 1:48 E FLAGLER ST
Mailing Address - Street 2:SUITE 370A
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-1011
Mailing Address - Country:US
Mailing Address - Phone:305-374-9793
Mailing Address - Fax:305-374-9784
Practice Address - Street 1:48 E FLAGLER ST
Practice Address - Street 2:SUITE 370A
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-1011
Practice Address - Country:US
Practice Address - Phone:305-374-9793
Practice Address - Fax:305-374-9784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1312915332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5585800001Medicare ID - Type UnspecifiedDMEOPS