Provider Demographics
NPI:1871543181
Name:HORIZON PROSTHETIC LABORATORIES, LLC
Entity type:Organization
Organization Name:HORIZON PROSTHETIC LABORATORIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CP
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:JANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:CP
Authorized Official - Phone:503-626-3163
Mailing Address - Street 1:8033 SW CIRRUS DR BLDG 21F
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-5983
Mailing Address - Country:US
Mailing Address - Phone:503-626-3163
Mailing Address - Fax:503-626-6224
Practice Address - Street 1:8033 SW CIRRUS DR BLDG 21F
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-5983
Practice Address - Country:US
Practice Address - Phone:503-626-3163
Practice Address - Fax:503-626-6224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11765413332B00000X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR816064000OtherREGENCE BLUE CROSS BLUE S
OR020594000OtherPACIFICARE
OR181578Medicaid
OR4604410001Medicare NSC