Provider Demographics
NPI:1629885462
Name:PROGRESSIVE FAMILY CARE LLC
Entity type:Organization
Organization Name:PROGRESSIVE FAMILY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-770-2782
Mailing Address - Street 1:3550 W WATERS AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-2773
Mailing Address - Country:US
Mailing Address - Phone:813-443-1364
Mailing Address - Fax:
Practice Address - Street 1:3550 W WATERS AVE STE 260
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2773
Practice Address - Country:US
Practice Address - Phone:813-443-1364
Practice Address - Fax:813-443-2592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty