1255486411 NPI number — HORSE TIME INC

Table of content: (NPI 1255486411)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255486411 NPI number — HORSE TIME INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HORSE TIME INC
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:
1255486411
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 880 BETHEL CHURCH ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30655
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-784-9777
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10385 HIGHWAY 278 EAST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COVINGTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-784-9777
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/25/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VIDRINE
Authorized Official First Name:
MAUREEN
Authorized Official Middle Name:
FRANCES
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
77078497777

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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