Provider Demographics
NPI:1013210251
Name:DR. ROBERT F HAILEY, DPM PSC
Entity Type:Organization
Organization Name:DR. ROBERT F HAILEY, DPM PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:HAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:270-247-9610
Mailing Address - Street 1:333 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-2309
Mailing Address - Country:US
Mailing Address - Phone:270-247-9610
Mailing Address - Fax:270-247-4077
Practice Address - Street 1:333 S 6TH ST
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-2309
Practice Address - Country:US
Practice Address - Phone:270-247-9610
Practice Address - Fax:270-247-4077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0846210001Medicare NSC
KY2003201Medicare PIN
T54171Medicare UPIN