MEDICARE: MITCHELL F HORAN MD PC

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		AZ

General Provider Information

NPI Number	:	1811974371
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MITCHELL F HORAN MD PC

Provider Business Mailing Address
First Line	:	PO BOX 429
Second Line	:
City	:	OVERGAARD
State	:	AZ
Zip	:	85933-0429
Country	:	US
Telephone Number	:	928-535-3616
Fax Number	:	928-535-3615

Provider Business Practice Location Address
First Line	:	2931 ARIZONA HWY 260
Second Line	:
City	:	OVERGAARD
State	:	AZ
Zip	:	85933-0429
Country	:	US
Telephone Number	:	928-535-3616
Fax Number	:	928-535-3615

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	KENDA HORAN
Credential	:
Telephone Number	:	928-535-3616

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	08/22/2020

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