Provider Demographics
NPI:1225142011
Name:HORIZON SURGICAL SPECIALISTS PA
Entity Type:Organization
Organization Name:HORIZON SURGICAL SPECIALISTS PA
Other - Org Name:CALDWELL SURGICAL ASSOCIATES PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:PURCELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-758-5501
Mailing Address - Street 1:PO BOX 1648
Mailing Address - Street 2:401 MULBERRY ST SW STE 101
Mailing Address - City:LENOIR
Mailing Address - State:NC
Mailing Address - Zip Code:28645-1648
Mailing Address - Country:US
Mailing Address - Phone:828-758-5501
Mailing Address - Fax:828-758-0080
Practice Address - Street 1:401 MULBERRY ST SW
Practice Address - Street 2:STE 101
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-1648
Practice Address - Country:US
Practice Address - Phone:828-758-5501
Practice Address - Fax:828-758-0080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-01463207N00000X
NC9800782208600000X
NC97011152086S0129X
NC8387213E00000X
213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8902545Medicaid
NCCJ4556OtherRR MEDICARE
NC0192Medicare PIN
NC8902545Medicaid