MEDICARE: HORIZON MEDICAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1811880461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HORIZON MEDICAL LLC

Provider Business Mailing Address
First Line	:	1957 THOMPSON RD STE E
Second Line	:
City	:	COOS BAY
State	:	OR
Zip	:	97420-2040
Country	:	US
Telephone Number	:	541-236-2778
Fax Number	:	866-892-1157

Provider Business Practice Location Address
First Line	:	1957 THOMPSON RD STE E
Second Line	:
City	:	COOS BAY
State	:	OR
Zip	:	97420-2040
Country	:	US
Telephone Number	:	541-236-2778
Fax Number	:	866-892-1157

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. LORI DIANE SHOTT
Credential	:	APRN, FNP-C
Telephone Number	:	541-236-2778

Provider Enumeration Date	:	06/02/2025
Last Update Date	:	11/06/2025

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