1013488204 NPI number — KAITLYN BAILEY CADACII

Table of content: KAITLYN BAILEY CADACII (NPI 1013488204)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013488204 NPI number — KAITLYN BAILEY CADACII

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAILEY
Provider First Name:
KAITLYN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CADACII
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1013488204
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2070 SALEM RIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RISING SUN
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47040-9435
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-584-8224
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
706 GREEN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47001-1506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-727-3504
Provider Business Practice Location Address Fax Number:
812-727-3504
Provider Enumeration Date:
12/16/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  CII-2078 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 611530 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: CII-2078 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com