Basic Information
| Provider Information | |||||||||
| NPI: | 1679568760 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAILEY | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 790309 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631790309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6365492380 | ||||||||
| FaxNumber: | 3145695974 | ||||||||
| Practice Location | |||||||||
| Address1: | 5319 HOAG DR | ||||||||
| Address2: | |||||||||
| City: | SHEFFIELD VILLAGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440351494 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4409306050 | ||||||||
| FaxNumber: | 4409348882 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2005 | ||||||||
| LastUpdateDate: | 03/10/2010 | ||||||||
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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 | 367500000X | RN165192 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | P00764395 | 01 | OH | MEDICARE RAILROAD | OTHER | 0918672 | 05 | OH | MEDICAID | 617230 | 01 | OH | BCBS | OTHER |