Provider Demographics
NPI:1881896710
Name:HAFENDORFER, PLLC
Entity type:Organization
Organization Name:HAFENDORFER, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:FRANCHESCA
Authorized Official - Middle Name:G
Authorized Official - Last Name:DOWNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-412-2992
Mailing Address - Street 1:10629 HENNING WAY
Mailing Address - Street 2:6
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2085
Mailing Address - Country:US
Mailing Address - Phone:502-412-2992
Mailing Address - Fax:502-412-6326
Practice Address - Street 1:10629 HENNING WAY
Practice Address - Street 2:6
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2085
Practice Address - Country:US
Practice Address - Phone:502-412-2992
Practice Address - Fax:502-412-6326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY13908261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7449Medicare ID - Type Unspecified