1194756429 NPI number — NIKOLAY PETROV HOROZOV M.D.

Table of content: (NPI 1427748417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194756429 NPI number — NIKOLAY PETROV HOROZOV M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOROZOV
Provider First Name:
NIKOLAY
Provider Middle Name:
PETROV
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1194756429
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
508 CASTLEBURY CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRANKLIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37064-5425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-423-6382
Provider Business Mailing Address Fax Number:
615-591-4286

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
53 CENTURY BOULEVARD, SUITE 200
Provider Second Line Business Practice Location Address:
MHM SERVICES, INC.
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37214-3693
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-884-0282
Provider Business Practice Location Address Fax Number:
615-884-0292
Provider Enumeration Date:
07/05/2006

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: 2084P0800X , with the licence number:  2006005513 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 431116734 . This is a "UNITED BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 758953 . This is a "HEALTHLINK HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11594367 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 431116734 . This is a "TRI CARE WEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1612489 . This is a "FIRST HEALTH/COVENTRY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 162776001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200376200 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 549264 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




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