MEDICARE: PROGRESSIVE PAIN AND REHABILITATION LLC

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	208VP0000X	Pain Medicine Physician

General Provider Information

NPI Number	:	1124561337
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE PAIN AND REHABILITATION LLC

Provider Business Mailing Address
First Line	:	3281 COLLEGE PARK DR
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77384-4501
Country	:	US
Telephone Number	:	346-220-8063
Fax Number	:	832-838-4362

Provider Business Practice Location Address
First Line	:	3281 COLLEGE PARK DR
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77384-4501
Country	:	US
Telephone Number	:	346-220-8063
Fax Number	:	832-838-4362

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EDWARD A NASH
Credential	:	M .D
Telephone Number	:	346-220-8063

Provider Enumeration Date	:	11/21/2016
Last Update Date	:	04/16/2024

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