Provider Demographics
NPI:1205074606
Name:PROGRESSIVE ORTHOPEDICS & PAIN MANAGEMENT, PA
Entity type:Organization
Organization Name:PROGRESSIVE ORTHOPEDICS & PAIN MANAGEMENT, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:T
Authorized Official - Last Name:ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-559-3061
Mailing Address - Street 1:6225 FM 2920 RD STE 205
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-3474
Mailing Address - Country:US
Mailing Address - Phone:832-559-3061
Mailing Address - Fax:832-559-3783
Practice Address - Street 1:6225 FM 2920 RD STE 205
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-3474
Practice Address - Country:US
Practice Address - Phone:832-559-3061
Practice Address - Fax:832-559-3783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH6938207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0A0365Medicare PIN