Provider Demographics
NPI:1871905166
Name:MINUTEMAN MEDICINE LLC
Entity type:Organization
Organization Name:MINUTEMAN MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:606-949-1006
Mailing Address - Street 1:17721 KY ROUTE 122
Mailing Address - Street 2:
Mailing Address - City:HI HAT
Mailing Address - State:KY
Mailing Address - Zip Code:41636-6235
Mailing Address - Country:US
Mailing Address - Phone:606-949-1006
Mailing Address - Fax:
Practice Address - Street 1:17721 KY ROUTE 122
Practice Address - Street 2:
Practice Address - City:HI HAT
Practice Address - State:KY
Practice Address - Zip Code:41636-6235
Practice Address - Country:US
Practice Address - Phone:606-949-1006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-21
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X, 261QR1300X
SCDO1053207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty