Organization
PROGRESSIVE WELLNESS CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NANCY MCCORKLE (BILLING MGR)
(217) 585-7910
Entity
Organization
Contact information
Practice address
5220 S 6TH STREET RD, SUITE 1500, SPRINGFIELD, IL 62703-5735
(217) 529-0300
(217) 529-2606
Mailing address
5220 S 6TH STREET RD, SUITE 1500, SPRINGFIELD, IL 62703-5735
(217) 529-0300
(217) 529-2606
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8432119
BLUE SHIELD OF ILLINOIS
IL
Enumeration date
09/06/2007
Last updated
09/06/2007
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