Provider Demographics
NPI:1306011614
Name:GERALD V HONCHELL
Entity type:Organization
Organization Name:GERALD V HONCHELL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER JEROME BEAUTIY BOUTIQUE
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:V
Authorized Official - Last Name:HONCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-269-5653
Mailing Address - Street 1:153 PATCHEN DR
Mailing Address - Street 2:59-61
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-4420
Mailing Address - Country:US
Mailing Address - Phone:859-269-5653
Mailing Address - Fax:859-269-5753
Practice Address - Street 1:153 PATCHEN DR
Practice Address - Street 2:59-61
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517
Practice Address - Country:US
Practice Address - Phone:859-269-5653
Practice Address - Fax:859-269-5753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4739080001Medicare PIN