Provider Demographics
NPI:1871595702
Name:PROGRESSIVE WOMEN'S CARE, INC.
Entity type:Organization
Organization Name:PROGRESSIVE WOMEN'S CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONI
Authorized Official - Middle Name:S
Authorized Official - Last Name:CANBY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-629-2677
Mailing Address - Street 1:PO BOX 92423
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0003
Mailing Address - Country:US
Mailing Address - Phone:330-629-2677
Mailing Address - Fax:
Practice Address - Street 1:7600 SOUTHERN BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-6085
Practice Address - Country:US
Practice Address - Phone:330-629-2677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2077229Medicaid
OH9293283Medicare ID - Type UnspecifiedMEDICARE