MEDICARE: HANDSHY MEDICAL CLINIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	170100000X	Ph.D. Medical Genetics	04-18856	KS

General Provider Information

NPI Number	:	1669571774
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HANDSHY MEDICAL CLINIC LLC

Provider Business Mailing Address
First Line	:	411 N WASHINGTON AVE
Second Line	:
City	:	IOLA
State	:	KS
Zip	:	66749-2352
Country	:	US
Telephone Number	:	620-365-8706
Fax Number	:	620-365-8707

Provider Business Practice Location Address
First Line	:	1525 MADISON ST STE 3
Second Line	:
City	:	FREDONIA
State	:	KS
Zip	:	66736-1704
Country	:	US
Telephone Number	:	620-378-2061
Fax Number	:	620-378-3014

Authorized Official
Title or Position	:	OWNER
Name	:	STANLEY E HANDSHY
Credential	:	M.D.
Telephone Number	:	620-365-8706

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	08/22/2020

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