Provider Demographics
NPI:1649691429
Name:SOUTHERN HORIZON HEALTHCARE, PLLC
Entity type:Organization
Organization Name:SOUTHERN HORIZON HEALTHCARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:BONTREGER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:469-645-0200
Mailing Address - Street 1:2014 JUSTIN RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HIGHLAND VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-7161
Mailing Address - Country:US
Mailing Address - Phone:469-645-0200
Mailing Address - Fax:469-637-0000
Practice Address - Street 1:2014 JUSTIN RD
Practice Address - Street 2:SUITE 104
Practice Address - City:HIGHLAND VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75077-7161
Practice Address - Country:US
Practice Address - Phone:469-645-0200
Practice Address - Fax:469-637-0000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-23
Last Update Date:2014-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX142996Medicare Oscar/Certification