Provider Demographics
NPI:1811185820
Name:SAMMY J HORTON, MD
Entity Type:Organization
Organization Name:SAMMY J HORTON, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMMY
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:325-646-5600
Mailing Address - Street 1:PO BOX 1665
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76804-1665
Mailing Address - Country:US
Mailing Address - Phone:325-646-5600
Mailing Address - Fax:325-646-7077
Practice Address - Street 1:120 S PARK DR
Practice Address - Street 2:SUITE D
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-5918
Practice Address - Country:US
Practice Address - Phone:325-646-5600
Practice Address - Fax:325-646-7077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167746001Medicaid
TX0073JGOtherBCBS #
TX167746001Medicaid