Contract Details
Progessive Medical, LLC
Facility name
Optum
Provider ID
P000009050
NPI
1255434205
Tax ID
311192384
Effective Date
1/17/2018
Last Updated
1/24/2018
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
70.00
Location Details
Address
175 Kelsey Lane
Tampa, FL 33619
United States
County
Hillsborough
Phone
4042719769 (Phone)
Billing Details
Address
P.O. Box 631480
Cincinnati, OH 45263
Billing Phone
4042719769
Specialty Type
Durable Medical Equipment & Medical Supplies
Map
Address