Provider Demographics
NPI:1215768197
Name:DYNAMIC HORIZONS LLC
Entity type:Organization
Organization Name:DYNAMIC HORIZONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LERSCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:660-493-3007
Mailing Address - Street 1:8417 CLINT DR
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-5330
Mailing Address - Country:US
Mailing Address - Phone:660-493-3007
Mailing Address - Fax:
Practice Address - Street 1:8417 CLINT DR
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-5330
Practice Address - Country:US
Practice Address - Phone:660-493-3007
Practice Address - Fax:660-235-2114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-12
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty