1811185820 NPI number — SAMMY J HORTON, MD

Table of content: (NPI 1811185820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811185820 NPI number — SAMMY J HORTON, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAMMY J HORTON, MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1811185820
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1665
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROWNWOOD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76804-1665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-646-5600
Provider Business Mailing Address Fax Number:
325-646-7077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 S PARK DR
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
BROWNWOOD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76801-5918
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-646-5600
Provider Business Practice Location Address Fax Number:
325-646-7077
Provider Enumeration Date:
10/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HORTON
Authorized Official First Name:
SAMMY
Authorized Official Middle Name:
JOE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
325-646-5600

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 167746001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0073JG . This is a "BCBS #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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