Healthcare Provider Details

I. General information

NPI: 1104943489
Provider Name (Legal Business Name): VERN H HORTON MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2827 FT MISSOULA RD
MISSOULA MT
59804
US

IV. Provider business mailing address

5750 COCHISE DRIVE
MISSOULA MT
59804-9746
US

V. Phone/Fax

Practice location:
  • Phone: 406-728-4100
  • Fax: 406-327-4502
Mailing address:
  • Phone: 406-251-2160
  • Fax: 406-251-2160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number3719
License Number StateMT

VIII. Authorized Official

Name: MRS. SUZANNE BALL HORTON
Title or Position: OFFICE MANAGER CORP SECRETARY
Credential:
Phone: 406-251-2160