Healthcare Provider Details

I. General information

NPI: 1831495506
Provider Name (Legal Business Name): HORIZON HEADACHE CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2011
Last Update Date: 12/22/2020
Certification Date: 12/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2365 HARRODSBURG ROAD SUITE B-100
LEXINGTON KY
40504
US

IV. Provider business mailing address

851 CORPORATE DR STE 110
LEXINGTON KY
40503-5429
US

V. Phone/Fax

Practice location:
  • Phone: 859-263-2222
  • Fax: 859-263-0020
Mailing address:
  • Phone: 859-263-2222
  • Fax: 859-263-0020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ATITAYA TRIMBLE
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 859-229-2703