Provider Demographics
NPI:1699783399
Name:PROGRESSIVE MEDICAL EQUIPMENT & SUPPLIES, INC
Entity type:Organization
Organization Name:PROGRESSIVE MEDICAL EQUIPMENT & SUPPLIES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:ASGHAR
Authorized Official - Last Name:RAZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-354-4091
Mailing Address - Street 1:5840 N CANTON CENTER RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48187-2684
Mailing Address - Country:US
Mailing Address - Phone:734-354-4091
Mailing Address - Fax:734-354-4092
Practice Address - Street 1:5840 N CANTON CENTER RD
Practice Address - Street 2:SUITE 210
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-2684
Practice Address - Country:US
Practice Address - Phone:734-354-4091
Practice Address - Fax:734-354-4092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5819160001Medicare NSC