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General NPI Number Information
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NPI Number | 1871905166
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Entity Type | Organization
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Legal Business Name | MINUTEMAN MEDICINE LLC
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Dates
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Enumeration Date | 05/21/2014
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Last Update Date | 10/05/2023
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Provider Practice Location Address
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Address Line | 17721 KY ROUTE 122
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City | HI HAT
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State | KY
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Zip | 41636-6235
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Country | US
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Telephone | 606-949-1006
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Fax |
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Provider Business Mailing Address
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Address Line | 17721 KY ROUTE 122
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City | HI HAT
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State | KY
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Zip | 41636-6235
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Country | US
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Telephone | 606-949-1006
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Fax |
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Authorized Official
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Title or Position | DO
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Name | MICHAEL SANDERS
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Credential | DO
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Telephone | 606-949-1006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine 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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | DO1053
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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