MEDICARE: MR. EARL BAILEY JR.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376J00000X	Homemaker

General Provider Information

NPI Number	:	1396397519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EARL BAILEY JR.

Provider Business Mailing Address
First Line	:	3537 STATION ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46218-1459
Country	:	US
Telephone Number	:	217-766-0563
Fax Number	:

Provider Business Practice Location Address
First Line	:	3537 STATION ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46218-1459
Country	:	US
Telephone Number	:	217-766-0563
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2019
Last Update Date	:	07/09/2019

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Directions to “ MR. EARL BAILEY JR. ” Practice Location

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