Healthcare Provider Details

I. General information

NPI: 1124166434
Provider Name (Legal Business Name): PROGRESS WEST HEALTHCARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TWO PROGRESS POINT PARKWAY
O FALLON MO
63368
US

IV. Provider business mailing address

2 PROGRESS POINT CT
O FALLON MO
63368-2208
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-3628
  • Fax: 314-996-3610
Mailing address:
  • Phone: 314-996-3628
  • Fax: 314-996-3610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. GINA CALDER
Title or Position: PRESIDENT
Credential:
Phone: 636-916-9401