Basic Information
| Provider Information | |||||||||
| NPI: | 1831308030 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HEALTH ACCESS NETWORK | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HAN GLENN ORTLEY, DO | ||||||||
| 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: | 5030 STATE RD | ||||||||
| Address2: | SUITE 2400 | ||||||||
| City: | DREXEL HILL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190264605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103941390 | ||||||||
| FaxNumber: | 6103941368 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | PRECHTL | ||||||||
| AuthorizedOfficialFirstName: | BRAD | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6103388386 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0858224026 | 01 | PA | IBC MHS GROUP | OTHER | 19297 | 01 | PA | AETNA EPDB GROUP | OTHER | 827125 | 01 | PA | PABS GROUP AA | OTHER |