Provider Demographics
NPI:1679832125
Name:PROGRESSIVE AMBULANCE SERVICE LLC
Entity type:Organization
Organization Name:PROGRESSIVE AMBULANCE SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:L
Authorized Official - Last Name:DOUMBIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-242-8211
Mailing Address - Street 1:PO BOX 2366
Mailing Address - Street 2:
Mailing Address - City:ALIEF
Mailing Address - State:TX
Mailing Address - Zip Code:77411-2366
Mailing Address - Country:US
Mailing Address - Phone:832-242-8211
Mailing Address - Fax:832-408-7615
Practice Address - Street 1:10101 HARWIN DR
Practice Address - Street 2:SUITE 395
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-1687
Practice Address - Country:US
Practice Address - Phone:832-242-8211
Practice Address - Fax:832-408-7615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-03
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10008083416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport