Healthcare Provider Details

I. General information

NPI: 1376771295
Provider Name (Legal Business Name): PROGRESSIVE PEDIATRICS - BEEBE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 06/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 HWY 64 W SUITE 3
BEEBE AR
72012-2094
US

IV. Provider business mailing address

807 KAMAK DR
BEEBE AR
72012-2087
US

V. Phone/Fax

Practice location:
  • Phone: 501-882-6660
  • Fax:
Mailing address:
  • Phone: 501-258-7944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: STEFFANY LANDRUM
Title or Position: OWNER
Credential:
Phone: 501-258-7944