Provider Demographics
NPI:1679156632
Name:PROHEALTH CLINIC
Entity type:Organization
Organization Name:PROHEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SIBI
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-417-3050
Mailing Address - Street 1:2846 KNIGHTS RD STE B
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-3552
Mailing Address - Country:US
Mailing Address - Phone:215-244-9894
Mailing Address - Fax:215-244-9896
Practice Address - Street 1:2846 KNIGHTS RD STE B
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-3552
Practice Address - Country:US
Practice Address - Phone:215-244-9894
Practice Address - Fax:215-244-9896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-28
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care