MEDICARE: PROGRESSIVE HOSPITAL

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
1	282E00000X	Long Term Care Hospital	2681HOS-12	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2681HOS-12	OTHER	NV	HOSPITAL LICENSE

General Provider Information

NPI Number	:	1609873215
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE HOSPITAL

Provider Business Mailing Address
First Line	:	4015 S MCLEOD DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-4305
Country	:	US
Telephone Number	:	702-433-2200
Fax Number	:	702-731-0581

Provider Business Practice Location Address
First Line	:	4015 S MCLEOD DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-4305
Country	:	US
Telephone Number	:	702-433-2200
Fax Number	:	702-731-0581

Authorized Official
Title or Position	:	CEO
Name	:	MRS. ROSEMARY THIELE III
Credential	:
Telephone Number	:	702-433-2200

Provider Enumeration Date	:	06/29/2005
Last Update Date	:	08/22/2020

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Directions to “PROGRESSIVE HOSPITAL ” Practice Location

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