Basic Information
| Provider Information | |||||||||
| NPI: | 1902139256 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BARTLEY ORTHOPAEDICS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 720 E. BROAD ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144616634 | ||||||||
| FaxNumber: | 6144611730 | ||||||||
| Practice Location | |||||||||
| Address1: | 1090 BEECHER CROSSING N | ||||||||
| Address2: | SUITE A | ||||||||
| City: | COAHANNA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144616634 | ||||||||
| FaxNumber: | 6144611730 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2009 | ||||||||
| LastUpdateDate: | 09/17/2009 | ||||||||
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| AuthorizedOfficialLastName: | BARTLEY | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6144616634 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | III | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 64468 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0922336 | 05 | OH | MEDICAID |