MEDICARE: DAMON TROY BARTLEY P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	50-003027	OH
2	363AS0400X	Surgical Physician Assistant
3	363AS0400X	Surgical Physician Assistant	10001498A	IN
4	363AS0400X	Surgical Physician Assistant	1601	TN
5	363A00000X	Physician Assistant	10001498A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780846428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAMON TROY BARTLEY P.A.

Provider Business Mailing Address
First Line	:	3019 N NATIONAL RD
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-3235
Country	:	US
Telephone Number	:	812-314-7617
Fax Number	:	812-314-7618

Provider Business Practice Location Address
First Line	:	3019 N NATIONAL RD
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-3235
Country	:	US
Telephone Number	:	812-314-7617
Fax Number	:	812-314-7618

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2008
Last Update Date	:	05/07/2024

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