Healthcare Provider Details

I. General information

NPI: 1871948414
Provider Name (Legal Business Name): PROSPECT HEALTH ACCESS NETWORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2016
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 W SPROUL RD SUITE 102
SPRINGFIELD PA
19064-2027
US

IV. Provider business mailing address

190 W SPROUL RD SUITE 102
SPRINGFIELD PA
19064-2027
US

V. Phone/Fax

Practice location:
  • Phone: 610-338-1820
  • Fax: 610-338-1825
Mailing address:
  • Phone: 610-338-1820
  • Fax: 610-338-1825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State

VIII. Authorized Official

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