Provider Demographics
NPI:1326561648
Name:WILLIAM H HANEY MD PLLC ULTIMATE MD
Entity Type:Organization
Organization Name:WILLIAM H HANEY MD PLLC ULTIMATE MD
Other - Org Name:ULTIMATE MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHOENBAECHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-220-8437
Mailing Address - Street 1:125 FAIRFAX AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4905
Mailing Address - Country:US
Mailing Address - Phone:502-897-6568
Mailing Address - Fax:502-890-3510
Practice Address - Street 1:125 FAIRFAX AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4905
Practice Address - Country:US
Practice Address - Phone:502-897-6568
Practice Address - Fax:502-890-3510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY25305207R00000X
208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty