Progressive Medical Lab, LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

800027387 Issued in FL

Legal business name

PROGRESSIVE MEDICAL LAB, LLC

Practice address

1690 Dunlawton Ave
Suite 120
Port Orange, FL 32127-8979

Phone

(386) 271-2273

Fax

(386) 845-0221

NPI assigned

Oct 10, 2014

Last updated

Oct 10, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mayada Al Hussaini

Title

MGR

Phone

(386) 795-4324

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1412899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412899200000",
    "number": "1225432867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 BEVILLE RD",
            "address_2": "SUITE 101",
            "city": "SOUTH DAYTONA",
            "state": "FL",
            "postal_code": "321192165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1690 DUNLAWTON AVE",
            "address_2": "SUITE 120",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321278979",
            "telephone_number": "386-271-2273",
            "fax_number": "386-845-0221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROGRESSIVE MEDICAL LAB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-10",
        "last_updated": "2014-10-10",
        "status": "A",
        "authorized_official_last_name": "AL HUSSAINI",
        "authorized_official_first_name": "MAYADA",
        "authorized_official_title_or_position": "MGR",
        "authorized_official_telephone_number": "386-795-4324"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "FL",
            "license": "800027387",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Primary Care Center of Port Orange
• Primary Care of Port Orange
• Primecare Acquisition Inc (PrimeCare Urgent Care Centers Port Orange)
• Pro-Motion Physical Therapy of Volusia Cty
• Proactive Transitions, Inc.
• Malgorzata Ptak
• Publix Super Markets Inc (Publix Pharmacy #1450)
• Publix Super Markets Inc (Publix Pharmacy #1259)
• Pura Vida Chiropractic LLC (Pura Vida Chiropractic)
• Katelyn Purnell

• Clinical Medical Laboratory in Port Orange, FL
• Providers in Port Orange, FL by specialty
• Clinical Medical Laboratory in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.