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NPI Code Detail

MEDICARE: PROGRESSIVE PINES LLC

MEDICARE: PROGRESSIVE PINES 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
1291U00000XClinical Medical Laboratory36D0667271OH

General Provider Information

NPI Number : 1497916274
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROGRESSIVE PINES LLC
Provider Business Mailing Address
First Line : 1552 N HONEYTOWN RD
Second Line :
City : WOOSTER
State : OH
Zip : 44691-9511
Country : US
Telephone Number : 330-264-0912
Fax Number :
Provider Business Practice Location Address
First Line : 1552 N HONEYTOWN RD
Second Line :
City : WOOSTER
State : OH
Zip : 44691-9511
Country : US
Telephone Number : 330-264-0912
Fax Number :
Authorized Official
Title or Position : CHIEF OPERATING OFFICER
Name : MR. SHAUL FLANK
Credential :
Telephone Number : 216-661-6800
Provider Enumeration Date : 06/24/2008
Last Update Date : 06/24/2008

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Directions to “PROGRESSIVE PINES LLC ” Practice Location

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