Basic Information
| Provider Information | |||||||||
| NPI: | 1396730552 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAILEY | ||||||||
| FirstName: | BILLY | ||||||||
| MiddleName: | DEAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 854 W. JAMES CAMPBELL BLVD | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 38401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9313889706 | ||||||||
| FaxNumber: | 9313889772 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 AUGUSTA AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | PADUCAH | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420035515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2705340046 | ||||||||
| FaxNumber: | 2705340048 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2005 | ||||||||
| LastUpdateDate: | 06/07/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RR0500X | 26804 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | 207RR0500X | 16622 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology |
ID Information
| ID | Type | State | Issuer | Description | 145768 | 01 | HEALTHLINK | OTHER | 000000049267 | 01 | KY | BLUE CROSS BLUE SHIELD | OTHER | 18D0700362 | 01 | CLIA | OTHER | 029602 | 01 | HEALTH ALLIANCE | OTHER |