MEDICARE: PROGRESSIVE HEALTH OF FAYETTE INC.

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	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1740142942
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROGRESSIVE HEALTH OF FAYETTE INC.

Provider Business Mailing Address
First Line	:	1 SAINT MARKS PL
Second Line	:
City	:	LA GRANGE
State	:	TX
Zip	:	78945-1250
Country	:	US
Telephone Number	:	999-999-9999
Fax Number	:

Provider Business Practice Location Address
First Line	:	750 W TRAVIS ST
Second Line	:
City	:	LA GRANGE
State	:	TX
Zip	:	78945-2522
Country	:	US
Telephone Number	:	999-999-9999
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	ROBERT QUENTIN WHITWELL JR.
Credential	:
Telephone Number	:	662-701-8766

Provider Enumeration Date	:	11/26/2025
Last Update Date	:	05/27/2026

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