Provider Demographics
NPI:1891154076
Name:HORIZON BIOADVANCE
Entity Type:Organization
Organization Name:HORIZON BIOADVANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-446-5111
Mailing Address - Street 1:1345 UNITY PL
Mailing Address - Street 2:SUITE 345
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-5760
Mailing Address - Country:US
Mailing Address - Phone:765-446-5111
Mailing Address - Fax:765-838-0972
Practice Address - Street 1:1345 UNITY PL
Practice Address - Street 2:SUITE 345
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5760
Practice Address - Country:US
Practice Address - Phone:765-446-5111
Practice Address - Fax:765-838-0972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-17
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044990A332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200173610Medicaid