Basic Information
| Provider Information | |||||||||
| NPI: | 1417583220 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROGRESSIVE CARE SOLUTIONS OF IN, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 150 EILEEN WAY UNIT 1 | ||||||||
| Address2: | |||||||||
| City: | SYOSSET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117915313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5168555255 | ||||||||
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| Practice Location | |||||||||
| Address1: | 745 N SWOPE ST | ||||||||
| Address2: | |||||||||
| City: | GREENFIELD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461401332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5168555255 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/13/2020 | ||||||||
| LastUpdateDate: | 03/17/2020 | ||||||||
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| AuthorizedOfficialLastName: | PATEL | ||||||||
| AuthorizedOfficialFirstName: | DEEPAK | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 5168555255 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 03/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
No ID Information.