Provider Demographics
NPI:1750607016
Name:SANDRA E TINLEY MD PA
Entity type:Organization
Organization Name:SANDRA E TINLEY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:TINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-641-2600
Mailing Address - Street 1:505 N RIDGEWAY DR
Mailing Address - Street 2:SUITE 160
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-5118
Mailing Address - Country:US
Mailing Address - Phone:817-641-2600
Mailing Address - Fax:817-641-2602
Practice Address - Street 1:505 N RIDGEWAY DR
Practice Address - Street 2:SUITE 160
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-5118
Practice Address - Country:US
Practice Address - Phone:817-240-6110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-12
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5544261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD31028Medicare UPIN