Healthcare Provider Details

I. General information

NPI: 1245420934
Provider Name (Legal Business Name): HANDY MEDICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2007
Last Update Date: 07/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BUCK CREEK RD
SIMPSONVILLE KY
40067-6674
US

IV. Provider business mailing address

101 BUCK CREEK RD
SIMPSONVILLE KY
40067-6674
US

V. Phone/Fax

Practice location:
  • Phone: 502-819-8709
  • Fax: 502-722-5551
Mailing address:
  • Phone: 502-819-8709
  • Fax: 502-722-5551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number279690
License Number StateKY

VIII. Authorized Official

Name: MS. KARLA JEANE GIBBS
Title or Position: CEO
Credential:
Phone: 502-819-8709