=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578488417
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HORIZON DERMATOLOGY AND SKIN SURGERY CENTER PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2026
-----------------------------------------------------
Last Update Date | 08/11/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1523 25TH ST NW
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-398-4097
-----------------------------------------------------
Fax | 423-769-0218
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1523 25TH ST NW
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-398-4097
-----------------------------------------------------
Fax | 423-769-0218
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LUKE MAXFIELD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 719-201-3373
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332900000X
-----------------------------------------------------
Taxonomy Name | Non-Pharmacy Dispensing Site
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------