Healthcare Provider Details

I. General information

NPI: 1871905166
Provider Name (Legal Business Name): MINUTEMAN MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2014
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17721 KY ROUTE 122
HI HAT KY
41636-6235
US

IV. Provider business mailing address

17721 KY ROUTE 122
HI HAT KY
41636-6235
US

V. Phone/Fax

Practice location:
  • Phone: 606-949-1006
  • Fax:
Mailing address:
  • Phone: 606-949-1006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberDO1053
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL SANDERS
Title or Position: DO
Credential: DO
Phone: 606-949-1006