Provider Demographics
NPI:1073378915
Name:PROSPECT PRIMARY CARE CLINIC
Entity Type:Organization
Organization Name:PROSPECT PRIMARY CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELURI
Authorized Official - Suffix:
Authorized Official - Credentials:AGPCNP-BC
Authorized Official - Phone:945-333-5481
Mailing Address - Street 1:PO BOX 6564
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-5115
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:670 W ARAPAHO RD STE 4
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-4213
Practice Address - Country:US
Practice Address - Phone:945-333-5481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty