Provider Demographics
NPI:1285813188
Name:HORUS MEDICAL
Entity type:Organization
Organization Name:HORUS MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KEYS
Authorized Official - Last Name:HENDERSHOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-402-5325
Mailing Address - Street 1:4217 CASWELL RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43031-9592
Mailing Address - Country:US
Mailing Address - Phone:614-402-5321
Mailing Address - Fax:740-967-4455
Practice Address - Street 1:4217 CASWELL RD
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:OH
Practice Address - Zip Code:43031-9592
Practice Address - Country:US
Practice Address - Phone:614-402-5321
Practice Address - Fax:740-967-4455
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HORUS MEDICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-26
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH282987332BN1400X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies