1033175179 NPI number — HORIZON HEALTHCARE MANAGEMENT

Table of content: (NPI 1033175179)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033175179 NPI number — HORIZON HEALTHCARE MANAGEMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HORIZON HEALTHCARE MANAGEMENT
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:
1033175179
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/07/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
185 STAFFORD UMBERGER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WYTHEVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24382-4439
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-228-5940
Provider Business Mailing Address Fax Number:
276-228-9292

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
185 STAFFORD UMBERGER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYTHEVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24382-4439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-228-5940
Provider Business Practice Location Address Fax Number:
276-228-9292
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COUNTS
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
276-228-5940

Provider Taxonomy Codes

  • Taxonomy code: 251F00000X , with the licence number:  0201003165 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251F00000X , with the licence number: M00559211 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251F00000X , with the licence number: 0000013211 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251F00000X , with the licence number: 08170 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 0201003165 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: M00559211 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 0000013211 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 08170 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: 0201003165 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , with the licence number: M00559211 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X , with the licence number: 0201003165 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336H0001X , with the licence number: M00559211 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X , with the licence number: 0000013211 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336H0001X , with the licence number: 08170 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0144254000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 240087 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 4810493 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0000013211 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0144254001 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008504806 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009106294 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4827967 . This is a "NCPDP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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