Basic Information
| Provider Information | |||||||||
| NPI: | 1851523641 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEW HORIZONS CONTINENCE MANAGEMENT LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2521 BEECHWOOD DR | ||||||||
| Address2: | |||||||||
| City: | ELIZABETHTON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376435062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236120654 | ||||||||
| FaxNumber: | 4235435323 | ||||||||
| Practice Location | |||||||||
| Address1: | 2521 BEECHWOOD DR | ||||||||
| Address2: | |||||||||
| City: | ELIZABETHTON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376435062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4236120654 | ||||||||
| FaxNumber: | 4235435323 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/13/2009 | ||||||||
| LastUpdateDate: | 08/13/2009 | ||||||||
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| AuthorizedOfficialLastName: | LAING | ||||||||
| AuthorizedOfficialFirstName: | BRENT | ||||||||
| AuthorizedOfficialMiddleName: | DAVID | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DRIECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4235423802 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QG0300X | 15696 | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine |
No ID Information.