1528037959 NPI number — BAILEY FAMILY PRACTICE CENTER, P.A.

Table of content: (NPI 1528037959)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528037959 NPI number — BAILEY FAMILY PRACTICE CENTER, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAILEY FAMILY PRACTICE CENTER, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FAMILY MEDICAL PRACTICE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528037959
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6321 DEANS ST
Provider Second Line Business Mailing Address:
P. O. BOX 280
Provider Business Mailing Address City Name:
BAILEY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27807-8641
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-235-4181
Provider Business Mailing Address Fax Number:
252-235-2950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6321 DEANS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAILEY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27807-8641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-235-4181
Provider Business Practice Location Address Fax Number:
252-235-2950
Provider Enumeration Date:
03/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BRNA
Authorized Official First Name:
THEODORE
Authorized Official Middle Name:
GEORGE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
252-235-4181

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  38590 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 89159H , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0159H . This is a "BLUE CROSS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5610052 . This is a "VIRIGINIA MEDICAID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: CM4727 . This is a "RAILROAD MEDICARE GROUP" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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