Provider Demographics
NPI:1154417426
Name:HORIZONS FAMILY PRACTICE LLC
Entity type:Organization
Organization Name:HORIZONS FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-693-7071
Mailing Address - Street 1:2741 NAVARRE AVE
Mailing Address - Street 2:STE 401
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3278
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2741 NAVARRE AVE
Practice Address - Street 2:STE 401
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3278
Practice Address - Country:US
Practice Address - Phone:419-693-7071
Practice Address - Fax:419-693-3051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2180321Medicaid
OH2180321Medicaid