MEDICARE: HEIDI MCMILLAN HORTON P.A.

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	363AM0700X	Medical Physician Assistant	PA02663	TX

General Provider Information

NPI Number	:	1992753248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEIDI MCMILLAN HORTON P.A.

Provider Business Mailing Address
First Line	:	1132 S BOWEN RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76013-2204
Country	:	US
Telephone Number	:	817-265-9700
Fax Number	:

Provider Business Practice Location Address
First Line	:	1132 S BOWEN RD
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76013-2204
Country	:	US
Telephone Number	:	817-265-9700
Fax Number	:	817-277-4164

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	07/08/2007

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