Healthcare Provider Details

I. General information

NPI: 1386642833
Provider Name (Legal Business Name): LANNY G. BRANSTETTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 02/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 E MAIN ST
HORSE CAVE KY
42749-1168
US

IV. Provider business mailing address

141 E MAIN ST
HORSE CAVE KY
42749-1168
US

V. Phone/Fax

Practice location:
  • Phone: 270-786-2466
  • Fax:
Mailing address:
  • Phone: 270-786-2466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. LANNEY BRANSTETTER
Title or Position: OWNER
Credential: RPH
Phone: 270-786-2466