Basic Information
| Provider Information | |||||||||
| NPI: | 1093925893 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HEALTH ACCESS NETWORK | ||||||||
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| OtherOrganizationName: | HAN SUBURBAN OBSTETRICS & GYNECOLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2602 W 9TH ST | ||||||||
| Address2: | |||||||||
| City: | CHESTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190132040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104977407 | ||||||||
| FaxNumber: | 6104977487 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 E CHESTER PIKE | ||||||||
| Address2: | |||||||||
| City: | RIDLEY PARK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190781703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105214311 | ||||||||
| FaxNumber: | 6105215995 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | PRECHTL | ||||||||
| AuthorizedOfficialFirstName: | BRAD | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6103388386 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 828732 | 01 | PA | PABS GROUP AA | OTHER | 5786493 | 01 | PA | AETNA EPDB GROUP | OTHER | 0859997000 | 01 | PA | IBC MHS GROUP | OTHER |