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NPI Code Detail

MEDICARE: PROGRESSIVE MEDICAL SPECIALISTS LLC

MEDICARE: PROGRESSIVE MEDICAL SPECIALISTS 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
1261QM2800XMethadone Clinic37-19CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18545OTHERCAMEDI-CAL

General Provider Information

NPI Number : 1932251550
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROGRESSIVE MEDICAL SPECIALISTS LLC
Provider Business Mailing Address
First Line : 4974 EL CAJON BLVD
Second Line : SUITE A
City : SAN DIEGO
State : CA
Zip : 92115-4677
Country : US
Telephone Number : 619-286-4600
Fax Number : 319-286-0060
Provider Business Practice Location Address
First Line : 4974 EL CAJON BLVD
Second Line : SUITE A
City : SAN DIEGO
State : CA
Zip : 92115-4677
Country : US
Telephone Number : 619-286-4600
Fax Number : 319-286-0060
Authorized Official
Title or Position : DIRECTOR
Name : MR. TIMOTHY BOYLAN
Credential :
Telephone Number : 619-286-4600
Provider Enumeration Date : 01/16/2007
Last Update Date : 11/29/2007

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