Provider Demographics
NPI:1851392724
Name:VAN HORN, THOMAS (PA)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:VAN HORN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 STECK AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-7566
Mailing Address - Country:US
Mailing Address - Phone:512-476-3556
Mailing Address - Fax:512-476-0195
Practice Address - Street 1:3215 STECK AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-7566
Practice Address - Country:US
Practice Address - Phone:512-476-3556
Practice Address - Fax:512-476-0195
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-02
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00103363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86N029OtherBLUE CROSS BLUE SHIELD
TX970004841OtherRAILROAD MEDICARE
TX117359303Medicaid
TX742843212OtherTAX ID
TXS24277Medicare UPIN
TX970004841OtherRAILROAD MEDICARE