Healthcare Provider Details

I. General information

NPI: 1396760401
Provider Name (Legal Business Name): HORNS MEDICAL SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 02/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 S PALESTINE ST
ATHENS TX
75751-5701
US

IV. Provider business mailing address

1901 S PALESTINE ST
ATHENS TX
75751-5701
US

V. Phone/Fax

Practice location:
  • Phone: 903-675-9360
  • Fax: 903-675-1570
Mailing address:
  • Phone: 903-675-9360
  • Fax: 903-675-1570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number2844334
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number0040665
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number0056656
License Number StateTX

VIII. Authorized Official

Name: MR. JERRY WAYNE HORN
Title or Position: VICE PRESIDENT
Credential:
Phone: 903-675-9360