Provider Demographics
NPI:1306268982
Name:PROGRESSIVE SURGICAL ASSIST LLC
Entity type:Organization
Organization Name:PROGRESSIVE SURGICAL ASSIST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:
Authorized Official - Last Name:PALUMBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-566-6658
Mailing Address - Street 1:12335 KINGSRIDE LN
Mailing Address - Street 2:#279
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-4116
Mailing Address - Country:US
Mailing Address - Phone:832-566-6658
Mailing Address - Fax:
Practice Address - Street 1:12335 KINGSRIDE LN
Practice Address - Street 2:#279
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-4116
Practice Address - Country:US
Practice Address - Phone:832-566-6658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty