1083706113 NPI number — JOSEPH C BAILEY MD

Table of content: JOSEPH C BAILEY MD (NPI 1083706113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083706113 NPI number — JOSEPH C BAILEY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAILEY
Provider First Name:
JOSEPH
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1083706113
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2050 MEADOWVIEW PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGSPORT
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37660
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-230-5000
Provider Business Mailing Address Fax Number:
423-230-5097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2428 KNOB CREEK ROAD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-282-5054
Provider Business Practice Location Address Fax Number:
423-230-5097
Provider Enumeration Date:
09/28/2006

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: 207RC0000X , with the licence number:  38534 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3894082 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5900865 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 139835 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 4087319 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: TN0108 . This is a "JDH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010087210 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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