Provider Demographics
NPI:1447442603
Name:S. F. HARTLEY, D.P.M., P.C.
Entity type:Organization
Organization Name:S. F. HARTLEY, D.P.M., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRACTIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:FRED
Authorized Official - Last Name:HARTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:2814-798-5311
Mailing Address - Street 1:112 W PASADENA BLVD
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:TX
Mailing Address - Zip Code:77536-4870
Mailing Address - Country:US
Mailing Address - Phone:281-479-5311
Mailing Address - Fax:281-479-0748
Practice Address - Street 1:112 W PASADENA BLVD
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:TX
Practice Address - Zip Code:77536-4870
Practice Address - Country:US
Practice Address - Phone:281-479-5311
Practice Address - Fax:281-479-0748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0691213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82J977OtherBC/BS OF TEXAS
TX00F38EOtherBC/BS OF TEXAS
TX82J977OtherMEDICARE INDIVIDUAL #
TX00F38EOtherBC/BS OF TEXAS
TX82J977OtherMEDICARE INDIVIDUAL #
TX00F38EMedicare PIN