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1588620058

NPI Code Detail

MEDICARE: DR. WILLIAM A. VANHORN MD

MEDICARE: DR. WILLIAM A. VANHORN MD

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	2084P0805X	Geriatric Psychiatry Physician	2014-00886	NC
2	2084P0800X	Psychiatry Physician	2014-00886	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	AA24050281	OTHER	SC	MEDICARE PALMETTO GBA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	492BA1	OTHER	NY	BLUE CROSS
2	050103000028	OTHER	NY	FIDELIS
4	10091505	OTHER	NY	CDPHP
5	11398516	OTHER	NY	CAQH
6	4141636	OTHER	NY	MVP
7	000408404001	OTHER	NY	BLUE SHIELD

General Provider Information

NPI Number	:	1588620058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM A. VANHORN MD

Provider Business Mailing Address
First Line	:	295 OLMSTED BLVD STE 2
Second Line	:
City	:	PINEHURST
State	:	NC
Zip	:	28374-9131
Country	:	US
Telephone Number	:	919-239-4711
Fax Number	:	888-899-3302

Provider Business Practice Location Address
First Line	:	164 WACCAMAW MEDICAL PARK DR
Second Line	:
City	:	CONWAY
State	:	SC
Zip	:	29526-8903
Country	:	US
Telephone Number	:	843-347-5060
Fax Number	:	843-347-3959

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	01/16/2019

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Directions to “ DR. WILLIAM A. VANHORN MD” Practice Location

Language	Start Address	Practice Location

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