Provider Demographics
NPI:1902916315
Name:HANDSHY MEDICAL CLINIC, LLC
Entity Type:Organization
Organization Name:HANDSHY MEDICAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:E
Authorized Official - Last Name:HANDSHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-378-2061
Mailing Address - Street 1:1525 MADISON ST STE 3
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:KS
Mailing Address - Zip Code:66736-1704
Mailing Address - Country:US
Mailing Address - Phone:620-378-2061
Mailing Address - Fax:620-378-3014
Practice Address - Street 1:1525 MADISON ST STE 3
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:KS
Practice Address - Zip Code:66736-1704
Practice Address - Country:US
Practice Address - Phone:620-378-2061
Practice Address - Fax:620-378-3014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-18856170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS111049Medicare PIN
KS178972Medicare Oscar/Certification