Provider Demographics
NPI:1801988266
Name:HORIZONS WEST MEDICAL GROUP A PROFESSIONAL CORPORTION
Entity type:Organization
Organization Name:HORIZONS WEST MEDICAL GROUP A PROFESSIONAL CORPORTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:BJORLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-630-2100
Mailing Address - Street 1:3911 AVENUE B
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361
Mailing Address - Country:US
Mailing Address - Phone:308-630-2131
Mailing Address - Fax:308-630-1890
Practice Address - Street 1:3911 AVENUE B
Practice Address - Street 2:SUITE 2100
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361
Practice Address - Country:US
Practice Address - Phone:308-630-2131
Practice Address - Fax:308-630-1890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NECD2704OtherPALMENTO GBA-RR MEDICARE
NE283821OtherMEDICARE OSCAR/CERTIFICAT
NE098285Medicare PIN
NE098318Medicare PIN
NECD2704OtherPALMENTO GBA-RR MEDICARE
NE098287Medicare PIN
NE283821Medicare Oscar/Certification