Provider Demographics
NPI:1528082088
Name:SAM L HORTON MD
Entity type:Organization
Organization Name:SAM L HORTON MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:HORTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-343-5106
Mailing Address - Street 1:1904 W 4TH ST S
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-4703
Mailing Address - Country:US
Mailing Address - Phone:918-343-5106
Mailing Address - Fax:918-343-5107
Practice Address - Street 1:1904 W 4TH ST S
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-4703
Practice Address - Country:US
Practice Address - Phone:918-343-5106
Practice Address - Fax:918-343-5107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY21098282NR1301X, 286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital
No282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK8HZ75EOtherPROVIDER NUMBER
OKH45106Medicare UPIN