1114043510 NPI number — PAMELA HORTON, PH.D., P.C.

Table of content: (NPI 1114043510)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114043510 NPI number — PAMELA HORTON, PH.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAMELA HORTON, PH.D., P.C.
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:
1114043510
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
226 SCENIC VIEW LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIGONIER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15658-1362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-238-1282
Provider Business Mailing Address Fax Number:
724-238-1281

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1618 WILLIAMS DR STE 6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78628-3660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-931-2162
Provider Business Practice Location Address Fax Number:
724-238-1281
Provider Enumeration Date:
03/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HORTON
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
724-238-1282

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  25250 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC0700X , with the licence number: PS009206L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 420631 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 286908 . This is a "SCOTT & WHITE HEALTH PLAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 131040 . This is a "VALUE OPTIONS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1617797 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1811967581 . This is a "NPI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0005584524 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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