Provider Demographics
NPI:1700349222
Name:PROGRESSIVE MEDICAL MANAGEMENT OF BATESVILLE LLC
Entity Type:Organization
Organization Name:PROGRESSIVE MEDICAL MANAGEMENT OF BATESVILLE LLC
Other - Org Name:PANOLA WOMEN'S AND CHILDREN'S CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-642-9821
Mailing Address - Street 1:303 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606-8608
Mailing Address - Country:US
Mailing Address - Phone:662-563-2163
Mailing Address - Fax:
Practice Address - Street 1:255 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-8629
Practice Address - Country:US
Practice Address - Phone:662-563-2163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROGRESSIVE MEDICAL MANAGEMENT OF BATESVILLE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-11
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty