Provider Demographics
NPI:1760474019
Name:HORIZON OB-GYN PLC
Entity Type:Organization
Organization Name:HORIZON OB-GYN PLC
Other - Org Name:EDDY OB/GYN PLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROXANNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:AILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-899-3000
Mailing Address - Street 1:215 S DOBSON RD
Mailing Address - Street 2:#1
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6227
Mailing Address - Country:US
Mailing Address - Phone:480-899-3000
Mailing Address - Fax:480-899-0527
Practice Address - Street 1:485 S DOBSON RD
Practice Address - Street 2:#100
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5602
Practice Address - Country:US
Practice Address - Phone:480-899-3000
Practice Address - Fax:480-899-0527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19027207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ296956Medicaid
E66707Medicare UPIN
AZ24487Medicare ID - Type Unspecified