Basic Information
| Provider Information | |||||||||
| NPI: | 1184133555 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HORIZON MEDICAL GROUP, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1345 UNITY PL STE 345 | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479055761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7654465200 | ||||||||
| FaxNumber: | 7658380972 | ||||||||
| Practice Location | |||||||||
| Address1: | 1345 UNITY PL STE 345 | ||||||||
| Address2: | |||||||||
| City: | LAFAYETTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 479055761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7654465200 | ||||||||
| FaxNumber: | 7658380972 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | PETERSON | ||||||||
| AuthorizedOfficialFirstName: | PENNY | ||||||||
| AuthorizedOfficialMiddleName: | FAY | ||||||||
| AuthorizedOfficialTitleorPosition: | OPERATIONS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7654465200 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 03/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RX0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology |
No ID Information.