Healthcare Provider Details

I. General information

NPI: 1063652931
Provider Name (Legal Business Name): HORIZON HEALTHCARE PROFESSIONAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2009
Last Update Date: 03/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3015 HIGHWAY 95 SUITE 107
BULLHEAD CITY AZ
86442-4334
US

IV. Provider business mailing address

3015 HIGHWAY 95 SUITE 107
BULLHEAD CITY AZ
86442-4334
US

V. Phone/Fax

Practice location:
  • Phone: 702-644-9250
  • Fax: 702-644-9252
Mailing address:
  • Phone: 702-644-9250
  • Fax: 702-644-9252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number9290
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: SALMAN MUHAMMAD MIRZA
Title or Position: OWNER
Credential:
Phone: 702-644-9250