Basic Information
| Provider Information | |||||||||
| NPI: | 1881845626 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROGRESSIVE PRIMARY CARE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10777 NALL AVE | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662111362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9137544599 | ||||||||
| FaxNumber: | 9137543996 | ||||||||
| Practice Location | |||||||||
| Address1: | 10777 NALL AVE | ||||||||
| Address2: | SUITE 140 | ||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662111362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9137544599 | ||||||||
| FaxNumber: | 9137543996 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2008 | ||||||||
| LastUpdateDate: | 10/09/2008 | ||||||||
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| AuthorizedOfficialLastName: | ANDERSON | ||||||||
| AuthorizedOfficialFirstName: | DOUGLAS | ||||||||
| AuthorizedOfficialMiddleName: | S. | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 9137544599 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.