NPIMap

Organization Active NPI

Prospect CCMC, LLC

  • Clinic/Center
  • Media, PA
National Provider Identifier
1740644053
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
710 S Middletown Rd
Media, PA 19063-5024
Phone
(610) 447-2000
Fax
(610) 447-6620
NPI assigned
Apr 12, 2016
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

710 S Middletown Rd
Media, PA 19063-5024

Mailing address

710 S Middletown Rd
Media, PA 19063-5024
Phone (610) 447-2000

Other names 1

  • tca school Other 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

710 S Old Middletown Rd
Media, PA 19063
Phone (610) 619-9870

NPI Registry JSON

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

{
    "created_epoch": "1460419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610668800000",
    "number": "1740644053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "710 S MIDDLETOWN RD",
            "city": "MEDIA",
            "state": "PA",
            "postal_code": "190635024",
            "telephone_number": "610-447-2000",
            "fax_number": "610-447-6620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 S MIDDLETOWN RD",
            "city": "MEDIA",
            "state": "PA",
            "postal_code": "190635024",
            "telephone_number": "610-447-2000",
            "fax_number": "610-447-6620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROSPECT CCMC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-12",
        "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": "tca school",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "tca school",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Media, 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.