Provider Demographics
NPI:1558588533
Name:HORIZON MEDICAL EQUIPMENT & SUPPLY, INC.
Entity Type:Organization
Organization Name:HORIZON MEDICAL EQUIPMENT & SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:IKPOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-525-1829
Mailing Address - Street 1:5511 SAN VICENTE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-2718
Mailing Address - Country:US
Mailing Address - Phone:323-525-1829
Mailing Address - Fax:323-525-1846
Practice Address - Street 1:5511 SAN VICENTE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-2718
Practice Address - Country:US
Practice Address - Phone:323-525-1829
Practice Address - Fax:323-525-1846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43456332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5501540001Medicare NSC