MEDICARE: PROGRESSIVE SLEEP & WELLNESS PLLC

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	1223G0001X	General Practice Dentistry	D4682	AZ

General Provider Information

NPI Number	:	1629426507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE SLEEP & WELLNESS PLLC

Provider Business Mailing Address
First Line	:	3303 E BASELINE RD STE 105
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85234-2739
Country	:	US
Telephone Number	:	480-507-1993
Fax Number	:	480-507-3876

Provider Business Practice Location Address
First Line	:	3303 E BASELINE RD STE 105
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85234-2739
Country	:	US
Telephone Number	:	480-507-1993
Fax Number	:	480-507-3876

Authorized Official
Title or Position	:	BILLING/FINANCIAL MANAGER
Name	:	MRS. JENNIFER EILEEN RICHEY
Credential	:
Telephone Number	:	480-507-1993

Provider Enumeration Date	:	06/01/2016
Last Update Date	:	06/01/2016

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