Basic Information
| Provider Information | |||||||||
| NPI: | 1861463184 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARTLEY | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 930 FRANKLIN ST SE | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565394080 | ||||||||
| FaxNumber: | 2565394099 | ||||||||
| Practice Location | |||||||||
| Address1: | 930 FRANKLIN ST SE | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565394080 | ||||||||
| FaxNumber: | 2565394099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2006 | ||||||||
| LastUpdateDate: | 05/08/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0011X | 10550 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 192874 | 05 | AL | MEDICAID | 510-49247 | 01 | AL | BCBS | OTHER | 515-99684 | 01 | AL | BCBS | OTHER | 510-49248 | 01 | AL | BCBS | OTHER | 515-99678 | 01 | AL | BCBS | OTHER | 4003557 | 01 | AETNA | OTHER | P00770780 | 01 | AL | RAILROAD MEDICARE | OTHER | 060037260 | 01 | RAILROAD MEDICARE | OTHER | 25-10123 | 01 | UNITED HEALTHCARE | OTHER | 510-49249 | 01 | AL | BCBS | OTHER | 0084896 | 01 | TN | BCBS | OTHER | 515-99683 | 01 | AL | BCBS | OTHER | 51033802 | 01 | AL | BCBS | OTHER |