Provider Demographics
NPI:1336336593
Name:PROGRESSIVE FAMILY FOOT CARE PC
Entity Type:Organization
Organization Name:PROGRESSIVE FAMILY FOOT CARE PC
Other - Org Name:DAVID F RAY DPM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:F
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:219-322-8894
Mailing Address - Street 1:966 W US HIGHWAY 30
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-1551
Mailing Address - Country:US
Mailing Address - Phone:219-322-8894
Mailing Address - Fax:219-322-0056
Practice Address - Street 1:966 W US HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-1551
Practice Address - Country:US
Practice Address - Phone:219-322-8894
Practice Address - Fax:219-322-0056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000703213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000088054OtherANTHEM
IN480015806OtherRAILROAD MEDICARE
IN100201670AMedicaid
IL61100087OtherBLUE SHIELD OF IL
IN000000088054OtherANTHEM
IN626860Medicare PIN
IN100201670AMedicaid