1164993549 NPI number — MS. JACQUELINE MARIE BAILEY MA, HHA, PHLEB, EKG

Table of content: MS. JACQUELINE MARIE BAILEY MA, HHA, PHLEB, EKG (NPI 1164993549)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164993549 NPI number — MS. JACQUELINE MARIE BAILEY MA, HHA, PHLEB, EKG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAILEY
Provider First Name:
JACQUELINE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA, HHA, PHLEB, EKG
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAILEY
Provider Other First Name:
J.MARIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
AAS
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1164993549
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1421 MEREDITH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45231-3215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-225-8611
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3382 DESHLER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45251-2106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-969-6190
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/11/2018

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: 171000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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