Provider Demographics
NPI:1861627630
Name:HORIZON MEDICAL TRANSPORT
Entity Type:Organization
Organization Name:HORIZON MEDICAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ABUBKKAR
Authorized Official - Middle Name:
Authorized Official - Last Name:DIRAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-491-6983
Mailing Address - Street 1:5707 LACEY BLVD SE
Mailing Address - Street 2:SUITE # 108
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-7228
Mailing Address - Country:US
Mailing Address - Phone:360-491-6983
Mailing Address - Fax:
Practice Address - Street 1:5707 LACEY BLVD SE
Practice Address - Street 2:SUITE # 108
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-7228
Practice Address - Country:US
Practice Address - Phone:360-491-6983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602 567 380343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)