Provider Demographics
NPI:1811982226
Name:HORTONS ORTHOTIC LAB, INC.
Entity type:Organization
Organization Name:HORTONS ORTHOTIC LAB, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-663-2908
Mailing Address - Street 1:5220 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-1857
Mailing Address - Country:US
Mailing Address - Phone:501-663-2908
Mailing Address - Fax:501-663-3994
Practice Address - Street 1:2909 S 66TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5003
Practice Address - Country:US
Practice Address - Phone:479-452-3959
Practice Address - Fax:479-452-4007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-13
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0414890002Medicare NSC