Provider Demographics
NPI:1871813170
Name:STANLEY A HORST MD PC
Entity type:Organization
Organization Name:STANLEY A HORST MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HORST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-359-0909
Mailing Address - Street 1:105 S BRYANT AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-6399
Mailing Address - Country:US
Mailing Address - Phone:405-359-0909
Mailing Address - Fax:405-348-5936
Practice Address - Street 1:105 S BRYANT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6399
Practice Address - Country:US
Practice Address - Phone:405-359-0909
Practice Address - Fax:405-348-5936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-09
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK12795207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100112800AMedicaid
OK444603123Medicare PIN
OKC95059Medicare UPIN