Provider Demographics
NPI:1235253923
Name:VICTOR L HORSLEY DPM LLC
Entity Type:Organization
Organization Name:VICTOR L HORSLEY DPM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:HORSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:618-222-6866
Mailing Address - Street 1:4901 WEST MAIN
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62226-4724
Mailing Address - Country:US
Mailing Address - Phone:618-222-1986
Mailing Address - Fax:618-222-1898
Practice Address - Street 1:4901 WEST MAIN
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-4724
Practice Address - Country:US
Practice Address - Phone:618-222-1986
Practice Address - Fax:618-222-1898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2008-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
016.004072213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK21303OtherDME PROVIDER
IL5492840001Medicare NSC