Provider Demographics
NPI:1295089621
Name:HORIZON FAMILY MEDICINE CENTER LLC
Entity type:Organization
Organization Name:HORIZON FAMILY MEDICINE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOMODU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-493-1053
Mailing Address - Street 1:3737 N MERIDIAN ST STE 501
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-4383
Mailing Address - Country:US
Mailing Address - Phone:317-493-1053
Mailing Address - Fax:317-426-2208
Practice Address - Street 1:3737 N MERIDIAN ST STE 501
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208
Practice Address - Country:US
Practice Address - Phone:317-493-1053
Practice Address - Fax:317-426-2208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-07
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
IN01057399A261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN15D2052802OtherCLIA (CMS)
IN1295089621OtherNPI