Basic Information
| Provider Information | |||||||||
| NPI: | 1801024799 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HORN | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | DALE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 N FANT ST | ||||||||
| Address2: | ACCOUNTING DEPARTMENT, ATTN: SHELIA WYATT | ||||||||
| City: | ANDERSON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296215708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8645122751 | ||||||||
| FaxNumber: | 8645123719 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 N FANT ST | ||||||||
| Address2: | |||||||||
| City: | ANDERSON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296215708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8645121335 | ||||||||
| FaxNumber: | 8645128575 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2009 | ||||||||
| LastUpdateDate: | 06/03/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 5101018232 | MI | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 1676 | SC | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | NPI # | 01 | SC | BLUE CROSS & BLUE CHOICE | OTHER | 003138408A | 05 | GA | MEDICAID | 016761 | 05 | SC | MEDICAID | 535117 | 01 | SC | UHC | OTHER | P01277557 | 01 | SC | RAILROAD MEDICARE | OTHER |