Provider Demographics
NPI:1598154981
Name:HORIZON 1 PLLC
Entity Type:Organization
Organization Name:HORIZON 1 PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:COLE
Authorized Official - Middle Name:W
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:208-343-0909
Mailing Address - Street 1:1000 N CURTIS RD STE 103
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-1345
Mailing Address - Country:US
Mailing Address - Phone:208-343-0909
Mailing Address - Fax:208-343-6282
Practice Address - Street 1:1000 N CURTIS RD STE 103
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-1345
Practice Address - Country:US
Practice Address - Phone:208-343-0909
Practice Address - Fax:208-343-6282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD4410OS261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental