PROHEALTH PHYSICIANS, INC.

Provider Demographics

• NPI: 1003996463
• Name: PROHEALTH PHYSICIANS, INC.
• Entity Type: Organization
• Organization Name: PROHEALTH PHYSICIANS, INC.
• Authorized Official - Title/Position: PRESIDENT & CEO
• Authorized Official - Prefix: MR
• Authorized Official - First Name: JACK
• Authorized Official - Last Name: REED
• Authorized Official - Phone: 860-284-5200
• Mailing Address - Street 1: 4 FARM SPRINGS ROAD
• Mailing Address - Street 2: PROHEALTH PHYSICIANS
• Mailing Address - City: FARMINGTON
• Mailing Address - State: CT
• Mailing Address - Zip Code: 06032-2573
• Mailing Address - Country: US
• Mailing Address - Phone: 860-284-5200
• Practice Address - Street 1: 4 FARM SPRINGS ROAD
• Practice Address - Street 2: PROHEALTH PHYSICIANS
• Practice Address - City: FARMINGTON
• Practice Address - State: CT
• Practice Address - Zip Code: 06032-2573
• Practice Address - Country: US
• Practice Address - Phone: 860-284-5200
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-10-17
• Last Update Date: 2008-08-06

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207Q00000X	Allopathic & Osteopathic Physicians	Family Medicine		Group - Single Specialty
No	103TC0700X	Behavioral Health & Social Service Providers	Psychologist	Clinical	Group - Single Specialty
No	207R00000X	Allopathic & Osteopathic Physicians	Internal Medicine		Group - Single Specialty
No	207RS0012X	Allopathic & Osteopathic Physicians	Internal Medicine	Sleep Medicine	Group - Single Specialty
No	207Y00000X	Allopathic & Osteopathic Physicians	Otolaryngology		Group - Single Specialty
No	208000000X	Allopathic & Osteopathic Physicians	Pediatrics		Group - Single Specialty
No	2080P0206X	Allopathic & Osteopathic Physicians	Pediatrics	Pediatric Gastroenterology	Group - Single Specialty
No	225100000X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers	Physical Therapist		Group - Single Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Single Specialty
No	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner		Group - Single Specialty
No	363LA2200X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Adult Health	Group - Single Specialty
No	363LF0000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Family	Group - Single Specialty
No	363LP0200X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Pediatrics	Group - Single Specialty
No	363LP2300X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner	Primary Care	Group - Single Specialty
No	364SA2200X	Physician Assistants & Advanced Practice Nursing Providers	Clinical Nurse Specialist	Adult Health	Group - Single Specialty