NPIMap

Organization Active NPI

Horizon Healthcare, Inc.

  • General Practice Physician
  • West Bend, WI
National Provider Identifier
1386042075
Registry record updated Dec 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
HORIZON HEALTHCARE, INC.
Practice address
724 Elm St
West Bend, WI 53095-3205
Phone
(414) 376-5577
Fax
(414) 376-5577
NPI assigned
Dec 11, 2014
Last updated
Dec 11, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Darren Matavka
Title
Executive Vice President
Phone
(414) 301-6383

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NU
Adult Health Nurse Practitioner 363LA2200X NU
General Practice Physician 208D00000X NU Primary

Addresses

Primary practice location

724 Elm St
West Bend, WI 53095-3205

Mailing address

4650 S Howell Ave
Milwaukee, WI 53207-5906
Phone (414) 376-5577

National Provider Directory

National Provider Directory
Tax ID family
Horizon Healthcare Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

724 Elm St
West Bend, WI 53095
Phone (262) 353-9701

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1418256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418256000000",
    "number": "1386042075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4650 S HOWELL AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532075906",
            "telephone_number": "414-376-5577",
            "fax_number": "414-376-5577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "724 ELM ST",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530953205",
            "telephone_number": "414-376-5577",
            "fax_number": "414-376-5577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HORIZON HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-11",
        "last_updated": "2014-12-11",
        "status": "A",
        "authorized_official_last_name": "MATAVKA",
        "authorized_official_first_name": "DARREN",
        "authorized_official_title_or_position": "EXECUTIVE VICE PRESIDENT",
        "authorized_official_telephone_number": "414-301-6383"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Bend, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.