Progressive Health Clinic, LLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

PROGRESSIVE HEALTH CLINIC, LLC

Practice address

29G Miracle Strip Pkwy SW
Fort Walton Beach, FL 32548-6655

Phone

(334) 437-4308

NPI assigned

Mar 25, 2019

Organization subpart

No

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

Authorized official

Name

Andrew A Godwin, DCNPI 1558808659

Title

Owner/Provider

Phone

(850) 374-3926

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Andrew Allen Godwin, D.C.

  • Chiropractor
  • Fort Walton Beach, FL
  • NPI 1558808659
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1553472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556064000000",
    "number": "1811457716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29G MIRACLE STRIP PKWY SW",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325486655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29G MIRACLE STRIP PKWY SW",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325486655",
            "telephone_number": "334-437-4308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROGRESSIVE HEALTH CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-25",
        "last_updated": "2019-04-24",
        "status": "A",
        "authorized_official_last_name": "GODWIN",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "850-374-3926",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Fort Walton Beach, FL
• Providers in Fort Walton Beach, FL by specialty
• Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.