Healthcare Provider Details

I. General information

NPI: 1003592841
Provider Name (Legal Business Name): BAILEY M CLANCY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DRIVE PEDIATRICS DC058.00
COLUMBIA MO
65212-0001
US

IV. Provider business mailing address

1 HOSPITAL DRIVE PEDIATRICS DC058.00
COLUMBIA MO
65212-0001
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-4438
  • Fax: 573-884-9992
Mailing address:
  • Phone: 573-882-4438
  • Fax: 573-884-9992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2023023784
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: