Provider Demographics
NPI:1568774768
Name:PROSPECT HEALTH SERVICES TX, INC.
Entity Type:Organization
Organization Name:PROSPECT HEALTH SERVICES TX, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JON
Authorized Official - Last Name:ELDERS
Authorized Official - Suffix:
Authorized Official - Credentials:ESQ
Authorized Official - Phone:714-788-1249
Mailing Address - Street 1:414 NAVARRO ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-2516
Mailing Address - Country:US
Mailing Address - Phone:210-271-2188
Mailing Address - Fax:210-271-2023
Practice Address - Street 1:414 NAVARRO ST
Practice Address - Street 2:SUITE 600
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-2516
Practice Address - Country:US
Practice Address - Phone:210-271-2188
Practice Address - Fax:210-271-2023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-06
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty