Provider Demographics
NPI:1285668996
Name:MARK POMPER, MD, PA
Entity Type:Organization
Organization Name:MARK POMPER, MD, PA
Other - Org Name:HORIZON MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:GULKIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-730-2333
Mailing Address - Street 1:PO BOX 2277
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140
Mailing Address - Country:US
Mailing Address - Phone:954-730-2333
Mailing Address - Fax:954-337-0633
Practice Address - Street 1:10860 SW 88TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2680
Practice Address - Country:US
Practice Address - Phone:954-730-2333
Practice Address - Fax:954-730-2337
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARK POMPER, MD, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-10
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252860600Medicaid