Healthcare Provider Details

I. General information

NPI: 1992708101
Provider Name (Legal Business Name): HORIZON THREE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 D ST STE B
CLEARWATER FL
33756-3362
US

IV. Provider business mailing address

240 N WASHINGTON BLVD
SARASOTA FL
34236-5945
US

V. Phone/Fax

Practice location:
  • Phone: 727-466-9361
  • Fax: 767-466-0612
Mailing address:
  • Phone: 941-925-3490
  • Fax: 941-953-4452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License NumberHCC5199
License Number StateFL

VIII. Authorized Official

Name: MR. MARTIN J KERN
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 941-925-3490