MEDICARE: P R HORTON RPH INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	59	IA
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	59	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	20136	OTHER	IA	WELLMARK BLUE CROSS BLUE SHIELD OF IOWA

General Provider Information

NPI Number	:	1104092816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	P R HORTON RPH INC

Provider Business Mailing Address
First Line	:	2609 APACHE CT
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51104-1504
Country	:	US
Telephone Number	:	712-224-2845
Fax Number	:	712-224-2846

Provider Business Practice Location Address
First Line	:	2609 APACHE CT
Second Line	:
City	:	SIOUX CITY
State	:	IA
Zip	:	51104-1504
Country	:	US
Telephone Number	:	712-224-2845
Fax Number	:	712-224-2846

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. PAUL R HORTON
Credential	:	RP
Telephone Number	:	712-224-2845

Provider Enumeration Date	:	05/02/2008
Last Update Date	:	05/02/2008

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Directions to “P R HORTON RPH INC ” Practice Location

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