Provider Demographics
NPI:1528063807
Name:HORINEK, PATRICK H (RPAC)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:H
Last Name:HORINEK
Suffix:
Gender:M
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2507
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-2507
Mailing Address - Country:US
Mailing Address - Phone:417-781-2807
Mailing Address - Fax:417-781-3309
Practice Address - Street 1:3105 MCCLELLAND BLVD
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1640
Practice Address - Country:US
Practice Address - Phone:417-781-2807
Practice Address - Fax:417-781-3309
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001032149363A00000X
KS1019363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P37054Medicare UPIN
000085252Medicare ID - Type UnspecifiedCPIN