NPIMap

Organization Active NPI

Prospect CCMC, LLC

  • Clinic/Center
  • Collingdale, PA
National Provider Identifier
1477113249
Registry record updated Jan 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
PROSPECT CCMC, LLC
Practice address
800 Macdade Blvd
Collingdale, PA 19023-3826
Phone
(610) 915-3496
NPI assigned
Jun 14, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Robert Jon Elders
Title
Secretary
Phone
(714) 788-1249

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

800 Macdade Blvd
Collingdale, PA 19023-3826

Mailing address

800 Macdade Blvd
Collingdale, PA 19023-3826
Phone (610) 915-3496

Other names 1

  • Prospect CCMC, LLC Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Prospect CCMC LLC26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

Organizations that report the same tax identification number in the National Provider Directory.

View all 25

Locations

800 Macdade Blvd
Collingdale, PA 19023
Phone (610) 938-9372

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560470400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610668800000",
    "number": "1477113249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 MACDADE BLVD",
            "city": "COLLINGDALE",
            "state": "PA",
            "postal_code": "190233826",
            "telephone_number": "610-915-3496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 MACDADE BLVD",
            "city": "COLLINGDALE",
            "state": "PA",
            "postal_code": "190233826",
            "telephone_number": "610-915-3496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROSPECT CCMC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-14",
        "last_updated": "2021-01-15",
        "certification_date": "2021-01-15",
        "status": "A",
        "authorized_official_last_name": "ELDERS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "JON",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "714-788-1249"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prospect CCMC, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Prospect CCMC, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Collingdale, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.