| Progressive Medical Center Sc | |
|
229 W Grand Ave Suite R Bensenville IL 60106-3399 | |
| (630) 238-9235 | |
| (630) 238-0426 |
| Full Name | Progressive Medical Center Sc |
|---|---|
| Speciality | Internal Medicine |
| Location | 229 W Grand Ave, Bensenville, Illinois |
| Authorized Official Name and Position | Gabriela Henriquez (OFFICE MANAGER) |
| Authorized Official Contact | 6302389235 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Progressive Medical Center Sc 229 W Grand Avenue Suite R Bensenville IL 60106-3365 Ph: (630) 238-9235 | Progressive Medical Center Sc 229 W Grand Ave Suite R Bensenville IL 60106-3399 Ph: (630) 238-9235 |
| NPI Number | 1851464549 |
|---|---|
| Provider Enumeration Date | 11/17/2006 |
| Last Update Date | 04/07/2011 |
| Medicare PECOS PAC ID | 5991778797 |
|---|---|
| Medicare Enrollment ID | O20040819000182 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851464549 | NPI | - | NPPES |
| 036103673 | Medicaid | IL | |
| 036109448 | Medicaid | IL | |
| 036078267 | Medicaid | IL | |
| 036087152 | Medicaid | IL | |
| 02205538 | Other | IL | BCBS GROUP NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036103673 (Illinois) | Secondary |
| 207R00000X | Internal Medicine | 036087152 (Illinois) | Primary |
| 208000000X | Pediatrics | 036078267 (Illinois) | Secondary |
| Provider Name | Ausencio Nunez |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1407996564 PECOS PAC ID: 5698760213 Enrollment ID: I20040414001854 |
| Provider Name | Rolando Henriquez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144370990 PECOS PAC ID: 2062407687 Enrollment ID: I20040415000031 |
| Provider Name | Hans Jonnathan Henriquez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1053725994 PECOS PAC ID: 7618267337 Enrollment ID: I20170719003774 |
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