Provider Demographics
NPI:1952606691
Name:PROGENIX LLC
Entity type:Organization
Organization Name:PROGENIX LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MARKETING
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-383-0435
Mailing Address - Street 1:10521 ROSEHAVEN ST
Mailing Address - Street 2:SUITE 180
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2876
Mailing Address - Country:US
Mailing Address - Phone:703-383-0435
Mailing Address - Fax:703-383-0544
Practice Address - Street 1:10521 ROSEHAVEN ST
Practice Address - Street 2:SUITE 180
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2876
Practice Address - Country:US
Practice Address - Phone:703-383-0435
Practice Address - Fax:703-383-0544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-11
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0206009630OtherCOMMONWEALTH OF VIRGINIA, BOARD OF PHARMACY, MEDICAL EQUIPMENT SUPPLIER PERMIT
468008OtherTHE JOINT COMMISSION ACCREDITATION