Basic Information
| Provider Information | |||||||||
| NPI: | 1750556460 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROGRESSIVE MEDICAL ASSOCIATES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3540 W SAHARA AVE | ||||||||
| Address2: | SUITE E-6 #244 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891025816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029216829 | ||||||||
| FaxNumber: | 7029216828 | ||||||||
| Practice Location | |||||||||
| Address1: | 2600 S RAINBOW BLVD | ||||||||
| Address2: | SUITE #108 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891464006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029216829 | ||||||||
| FaxNumber: | 7029216828 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2008 | ||||||||
| LastUpdateDate: | 05/11/2010 | ||||||||
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| AuthorizedOfficialLastName: | SHEIKH | ||||||||
| AuthorizedOfficialFirstName: | SAMEER | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7029216829 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 12056 | NV | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 12056 | NV | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | FS0052489 | 01 | NV | DEA | OTHER | 100511269 | 05 | NV | MEDICAID |