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General NPI Number Information
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NPI Number | 1326561648
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Entity Type | Organization
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Legal Business Name | WILLIAM H HANEY MD PLLC ULTIMATE MD
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Dates
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Enumeration Date | 07/18/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 125 FAIRFAX AVE
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City | LOUISVILLE
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State | KY
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Zip | 40207-4905
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Country | US
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Telephone | 502-897-6568
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Fax | 502-890-3510
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Provider Business Mailing Address
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Address Line | 125 FAIRFAX AVE
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City | LOUISVILLE
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State | KY
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Zip | 40207-4905
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Country | US
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Telephone | 502-897-6568
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Fax | 502-890-3510
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Authorized Official
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Title or Position | CREDENTIALING SUPPORT
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Name | JULIE SCHOENBAECHLER
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Credential |
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Telephone | 502-220-8437
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25305
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License Number State | KY
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