Healthcare Provider Details

I. General information

NPI: 1528413002
Provider Name (Legal Business Name): PROSPECT HEALTH ACCESS NETWORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 W SPROUL RD SUITE 110
SPRINGFIELD PA
19064-2045
US

IV. Provider business mailing address

196 W SPROUL RD SUITE 110
SPRINGFIELD PA
19064-2045
US

V. Phone/Fax

Practice location:
  • Phone: 610-328-8830
  • Fax: 610-328-8981
Mailing address:
  • Phone: 610-328-8830
  • Fax: 610-328-8981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT JON ELDERS
Title or Position: SECRETARY
Credential:
Phone: 714-788-1249