1477504561 NPI number — HORSLEY PSC

Table of content: (NPI 1477504561)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477504561 NPI number — HORSLEY PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HORSLEY PSC
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:
1477504561
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:
PO BOX 1165
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47706-1165
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-467-2392
Provider Business Mailing Address Fax Number:
812-471-6650

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
444 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISONVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42431-2871
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-821-4444
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HORSLEY
Authorized Official First Name:
BROOKS
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
270-831-4444

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 65939399 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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