Provider Demographics
NPI:1346337508
Name:HORODNIC FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:HORODNIC FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:HORODNIC
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:724-934-5040
Mailing Address - Street 1:103 N MEADOWS DR
Mailing Address - Street 2:STE 220
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8369
Mailing Address - Country:US
Mailing Address - Phone:724-934-5040
Mailing Address - Fax:724-934-5051
Practice Address - Street 1:103 N MEADOWS DR
Practice Address - Street 2:STE 220
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8369
Practice Address - Country:US
Practice Address - Phone:724-934-5040
Practice Address - Fax:724-934-5051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015470360014Medicaid