Basic Information
| Provider Information | |||||||||
| NPI: | 1528037959 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BAILEY FAMILY PRACTICE CENTER, P.A. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FAMILY MEDICAL PRACTICE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6321 DEANS ST | ||||||||
| Address2: | P. O. BOX 280 | ||||||||
| City: | BAILEY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278078641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2522354181 | ||||||||
| FaxNumber: | 2522352950 | ||||||||
| Practice Location | |||||||||
| Address1: | 6321 DEANS ST | ||||||||
| Address2: | |||||||||
| City: | BAILEY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278078641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2522354181 | ||||||||
| FaxNumber: | 2522352950 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2006 | ||||||||
| LastUpdateDate: | 05/08/2008 | ||||||||
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| AuthorizedOfficialLastName: | BRNA | ||||||||
| AuthorizedOfficialFirstName: | THEODORE | ||||||||
| AuthorizedOfficialMiddleName: | GEORGE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2522354181 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2300X | 38590 | NC | Y | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |
ID Information
| ID | Type | State | Issuer | Description | 89159H | 05 | NC | MEDICAID | 0159H | 01 | NC | BLUE CROSS | OTHER | 5610052 | 01 | NC | VIRIGINIA MEDICAID | OTHER | CM4727 | 01 | NC | RAILROAD MEDICARE GROUP | OTHER |