Healthcare Provider Details

I. General information

NPI: 1669591194
Provider Name (Legal Business Name): HEALTH ACCESS NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 10/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 KEYSTONE AVE
DREXEL HILL PA
19026-1129
US

IV. Provider business mailing address

PO BOX 8500-6355
PHILADELPHIA PA
19178-0001
US

V. Phone/Fax

Practice location:
  • Phone: 610-622-8200
  • Fax:
Mailing address:
  • Phone: 610-497-7520
  • Fax: 610-497-7525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1678220
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerPA BLUE SHIELD GROUP

VIII. Authorized Official

Name: MR. BRAD PRECHTL
Title or Position: PRESDIDENT
Credential:
Phone: 610-338-8386