1386601342 NPI number — DR. TERENCE J HADLEY M.D.

Table of content: DR. TERENCE J HADLEY M.D. (NPI 1386601342)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386601342 NPI number — DR. TERENCE J HADLEY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HADLEY
Provider First Name:
TERENCE
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386601342
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 776347
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60677-6347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-272-5052
Provider Business Mailing Address Fax Number:
502-629-6217

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2355 POPLAR LEVEL RD
Provider Second Line Business Practice Location Address:
SUITE 405
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40217-1384
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-272-5754
Provider Business Practice Location Address Fax Number:
502-272-5339
Provider Enumeration Date:
04/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  24912 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 200058620 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 830006323 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 4045199 . This is a "AETNA PROVIDER NUMB" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1112298 . This is a "PASSPORT PROVIDER NUMB" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 3964324 . This is a "CIGNA PROVIDER NUMB" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000065300 . This is a "ANTHEM PROVIDER NUMB" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000020583E . This is a "HUMANA PROVIDER NUMB" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 64249121 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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