Healthcare Provider Details

I. General information

NPI: 1558959387
Provider Name (Legal Business Name): MICHAEL W HORNE CSFA, LSA, CST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 SKIPWITH RD
RICHMOND VA
23229-5205
US

IV. Provider business mailing address

10604 CUSSONS RD
GLEN ALLEN VA
23060-2634
US

V. Phone/Fax

Practice location:
  • Phone: 804-289-4500
  • Fax:
Mailing address:
  • Phone: 229-569-5096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: