Basic Information
| Provider Information | |||||||||
| NPI: | 1245332378 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HORIZON FAMILY MEDICINE, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 410 CANTERBURY RD | ||||||||
| Address2: | |||||||||
| City: | SMITHFIELD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275774861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199345149 | ||||||||
| FaxNumber: | 9199345632 | ||||||||
| Practice Location | |||||||||
| Address1: | 410 CANTERBURY RD | ||||||||
| Address2: | |||||||||
| City: | SMITHFIELD | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275774861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199345149 | ||||||||
| FaxNumber: | 9199345632 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2006 | ||||||||
| LastUpdateDate: | 09/20/2011 | ||||||||
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| AuthorizedOfficialLastName: | LIVERMAN | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | T | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE-PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9199345149 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 39285 | NC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 8902686 | 05 | NC | MEDICAID | CA2296 | 01 | NC | RAILROAD MEDICARE | OTHER |