Healthcare Provider Details

I. General information

NPI: 1679150890
Provider Name (Legal Business Name): AUSTIN FORSYTHE HORN I
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 04/22/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 W MAIN ST
SUBLIMITY OR
97385-9798
US

IV. Provider business mailing address

MEDICAL CITY ARLINGTON 3301 MATLOCK ROAD,
ARLINGTON TX
76015-9798
US

V. Phone/Fax

Practice location:
  • Phone: 503-480-5388
  • Fax:
Mailing address:
  • Phone: 503-480-5388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: