Healthcare Provider Details

I. General information

NPI: 1669571774
Provider Name (Legal Business Name): HANDSHY MEDICAL CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 MADISON ST STE 3
FREDONIA KS
66736-1704
US

IV. Provider business mailing address

411 N WASHINGTON AVE
IOLA KS
66749-2352
US

V. Phone/Fax

Practice location:
  • Phone: 620-378-2061
  • Fax: 620-378-3014
Mailing address:
  • Phone: 620-365-8706
  • Fax: 620-365-8707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number04-18856
License Number StateKS

VIII. Authorized Official

Name: STANLEY E HANDSHY
Title or Position: OWNER
Credential: M.D.
Phone: 620-365-8706