Provider Demographics
NPI:1831606722
Name:PROGRESSIVE HEALTH MEDICAL CENTER PLLC
Entity type:Organization
Organization Name:PROGRESSIVE HEALTH MEDICAL CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGEMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-775-5857
Mailing Address - Street 1:15110 DALLAS PKWY STE 630
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-4635
Mailing Address - Country:US
Mailing Address - Phone:972-792-0204
Mailing Address - Fax:972-792-0290
Practice Address - Street 1:15110 DALLAS PKWY STE 630
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-4635
Practice Address - Country:US
Practice Address - Phone:972-792-0204
Practice Address - Fax:972-792-0204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX09927111N00000X
TXQ9070208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty