Provider Demographics
NPI:1225088784
Name:HORNE, BENJAMIN SHINN III (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:SHINN
Last Name:HORNE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT STE 212
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4536
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 PATEWOOD DR
Practice Address - Street 2:SUITE A200
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3593
Practice Address - Country:US
Practice Address - Phone:864-454-5120
Practice Address - Fax:864-454-5106
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC119622080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC119623Medicaid
SCD181707951Medicare PIN
SC119623Medicaid
SCD181703365Medicare PIN
SC57-6007863083OtherBLUE CHOICE OF SC
SCD181707951Medicare PIN
SCD18170Medicare UPIN
SC6573361OtherCIGNA
SC4283098OtherAETNA