Provider Demographics
NPI:1336175595
Name:HORIZON MEDICAL CORPORATION PC
Entity Type:Organization
Organization Name:HORIZON MEDICAL CORPORATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-876-1735
Mailing Address - Street 1:4 KELLY ST STE 4
Mailing Address - Street 2:
Mailing Address - City:ARCHBALD
Mailing Address - State:PA
Mailing Address - Zip Code:18403-1627
Mailing Address - Country:US
Mailing Address - Phone:570-876-1735
Mailing Address - Fax:570-876-1813
Practice Address - Street 1:1721 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-1995
Practice Address - Country:US
Practice Address - Phone:570-961-9947
Practice Address - Fax:570-341-5043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA40158OtherBLUE SHIELD GROUP NUMBER
PA0017929090002Medicaid
PA809779OtherFIRST PRIORITY HEALTH GRO
PA40158OtherBLUE SHIELD GROUP NUMBER
PA809779OtherFIRST PRIORITY HEALTH GRO