MEDICARE: PROGRESSIVE PROSTHETIC & ORTHOPEDIC SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1124006713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE PROSTHETIC & ORTHOPEDIC SERVICES, INC.

Provider Business Mailing Address
First Line	:	380 CLEVELAND PL
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-6529
Country	:	US
Telephone Number	:	757-456-5501
Fax Number	:	757-671-7525

Provider Business Practice Location Address
First Line	:	380 CLEVELAND PL
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-6529
Country	:	US
Telephone Number	:	757-456-5501
Fax Number	:	757-671-7525

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MATTHIAS JESSE HALL
Credential	:	CP
Telephone Number	:	757-456-5501

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	09/10/2009

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