Provider Demographics
NPI:1427042308
Name:HORTON'S ORTHOTIC LAB, INC.
Entity Type:Organization
Organization Name:HORTON'S ORTHOTIC LAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-663-2908
Mailing Address - Street 1:5220 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-1857
Mailing Address - Country:US
Mailing Address - Phone:501-663-2908
Mailing Address - Fax:501-663-3994
Practice Address - Street 1:5220 W 12TH ST
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72204-1857
Practice Address - Country:US
Practice Address - Phone:501-663-2908
Practice Address - Fax:501-663-3994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR=========OtherTAX IDENTIFICATION
AR0414890001Medicare NSC
AR43936Medicare ID - Type UnspecifiedMEDICARE NUMBER