MEDICARE: PROGRESSIVE ORTHOPEDICS & PAIN MANAGEMENT, PA

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	207RS0010X	Sports Medicine (Internal Medicine) Physician	H6938	TX

General Provider Information

NPI Number	:	1205074606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE ORTHOPEDICS & PAIN MANAGEMENT, PA

Provider Business Mailing Address
First Line	:	6225 FM 2920 RD STE 205
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-3474
Country	:	US
Telephone Number	:	832-559-3061
Fax Number	:	832-559-3783

Provider Business Practice Location Address
First Line	:	6225 FM 2920 RD STE 205
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77379-3474
Country	:	US
Telephone Number	:	832-559-3061
Fax Number	:	832-559-3783

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. ERNEST T ROMAN
Credential	:
Telephone Number	:	832-559-3061

Provider Enumeration Date	:	01/23/2009
Last Update Date	:	03/01/2012

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