Provider Demographics
NPI:1215435110
Name:HADLEY HEALTH SERVICES LLC
Entity type:Organization
Organization Name:HADLEY HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:HADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-924-0938
Mailing Address - Street 1:1920 N BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-3722
Mailing Address - Country:US
Mailing Address - Phone:405-924-0938
Mailing Address - Fax:405-759-9005
Practice Address - Street 1:1920 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-3722
Practice Address - Country:US
Practice Address - Phone:405-924-0938
Practice Address - Fax:405-759-9005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18911207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty