1467412049 NPI number — BROOKS A HORSLEY MD

Table of content: BROOKS A HORSLEY MD (NPI 1467412049)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467412049 NPI number — BROOKS A HORSLEY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HORSLEY
Provider First Name:
BROOKS
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467412049
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1165
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47706-1165
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-467-2392
Provider Business Mailing Address Fax Number:
812-471-6650

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
611 HAMMOND PLZ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOPKINSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42240-4971
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-885-1950
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  226072 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 23087 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02497556 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 64230873 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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