MEDICARE: HORIZON INJURY CENTER, LLC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1659506418
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HORIZON INJURY CENTER, LLC

Provider Business Mailing Address
First Line	:	2221 N HIMES AVE STE A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-3139
Country	:	US
Telephone Number	:	813-877-9870
Fax Number	:	813-877-9869

Provider Business Practice Location Address
First Line	:	2221 N HIMES AVE STE A
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-3139
Country	:	US
Telephone Number	:	813-877-9870
Fax Number	:	813-877-9869

Authorized Official
Title or Position	:	OWNER
Name	:	ALBERT E FORD
Credential	:	D.O.
Telephone Number	:	813-877-9870

Provider Enumeration Date	:	05/22/2009
Last Update Date	:	05/22/2009

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