Provider Demographics
NPI: | 1487663035 |
---|---|
Name: | HORIZON FAMILY MEDICINE OF BRISTOL, INC |
Entity Type: | Organization |
Organization Name: | HORIZON FAMILY MEDICINE OF BRISTOL, INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRACTICE MANAGER/OWNER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | MICHAEL |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | KOVACS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 276-642-0623 |
Mailing Address - Street 1: | 999 EXECUTIVE PARK BLVD |
Mailing Address - Street 2: | SUITE 201 |
Mailing Address - City: | KINGSPORT |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 37660-4632 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 423-224-3250 |
Mailing Address - Fax: | 423-224-3258 |
Practice Address - Street 1: | 103 BRISTOL EAST RD |
Practice Address - Street 2: | |
Practice Address - City: | BRISTOL |
Practice Address - State: | VA |
Practice Address - Zip Code: | 24202-5501 |
Practice Address - Country: | US |
Practice Address - Phone: | 276-642-0623 |
Practice Address - Fax: | 276-642-0208 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-08-05 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Single Specialty |