=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811204357
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PROGRESSIVE HEALTH FAMILY MEDICINE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2010
-----------------------------------------------------
Last Update Date | 09/03/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8901 VIRGINIA PKWY SUITE 700
-----------------------------------------------------
City | MCKINNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75071-5701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-369-1871
-----------------------------------------------------
Fax | 972-369-1872
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8901 VIRGINIA PKWY SUITE 700
-----------------------------------------------------
City | MCKINNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75071-5701
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-369-1871
-----------------------------------------------------
Fax | 972-369-1872
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DR. HEMA HARIDAS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 479-719-6553
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | M7246
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------