Provider Demographics
NPI:1467648568
Name:HORIZON TWENTY ONE MEDICAL, PA
Entity Type:Organization
Organization Name:HORIZON TWENTY ONE MEDICAL, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:W
Authorized Official - Last Name:MORROW
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:512-260-2777
Mailing Address - Street 1:PO BOX 3909
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78630-3909
Mailing Address - Country:US
Mailing Address - Phone:512-260-2777
Mailing Address - Fax:512-259-5777
Practice Address - Street 1:715 DISCOVERY BLVD
Practice Address - Street 2:STE. 112
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2287
Practice Address - Country:US
Practice Address - Phone:512-260-2777
Practice Address - Fax:512-259-5777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4566261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00898VMedicare UPIN