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General NPI Number Information
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NPI Number | 1740142942
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Entity Type | Organization
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Legal Business Name | PROGRESSIVE HEALTH OF FAYETTE INC.
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Dates
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Enumeration Date | 11/26/2025
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Last Update Date | 11/26/2025
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Provider Practice Location Address
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Address Line | 750 W TRAVIS ST
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City | LA GRANGE
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State | TX
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Zip | 78945-2522
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Country | US
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Telephone | 999-999-9999
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Fax |
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Provider Business Mailing Address
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Address Line | 750 W TRAVIS ST
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City | LA GRANGE
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State | TX
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Zip | 78945-2522
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Country | US
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Telephone | 999-999-9999
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ROBERT QUENTIN WHITWELL
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Credential |
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Telephone | 662-701-9346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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