Provider Demographics
NPI:1821660671
Name:BLUE HORSE MEDICAL, LLC
Entity Type:Organization
Organization Name:BLUE HORSE MEDICAL, LLC
Other - Org Name:ANTHEM PSYCHIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:623-400-1501
Mailing Address - Street 1:39506 N DAISY MOUNTAIN DR STE 122418
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-6078
Mailing Address - Country:US
Mailing Address - Phone:623-400-1501
Mailing Address - Fax:623-246-4224
Practice Address - Street 1:41818 N VENTURE DR STE 150
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-3190
Practice Address - Country:US
Practice Address - Phone:623-400-1501
Practice Address - Fax:623-246-4224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-12
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty