Provider Demographics
NPI:1255434205
Name:PROGRESSIVE MEDICAL, LLC
Entity type:Organization
Organization Name:PROGRESSIVE MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REGULATORY COMPLIANCE
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-212-8264
Mailing Address - Street 1:250 PROGRESSIVE WAY
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-9615
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:250 PROGRESSIVE WAY
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-9615
Practice Address - Country:US
Practice Address - Phone:614-794-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCPO.021781350-123336M0002X
343900000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336M0002XSuppliersPharmacyMail Order Pharmacy
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
040026599OtherU.S. DEPT. OF LABOR
040026599OtherU.S. DEPT. OF LABOR
OH0656544Medicaid
OH=========-00OtherOH BWC
040026599OtherU.S. DEPT. OF LABOR
0413270001Medicare ID - Type Unspecified