Healthcare Provider Details

I. General information

NPI: 1073855276
Provider Name (Legal Business Name): BAILEY C RUNKLES D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BAILEY C HARTSWICK

II. Dates (important events)

Enumeration Date: 03/26/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2422 20TH ST SW
JAMESTOWN ND
58401-6201
US

IV. Provider business mailing address

717 S HOUSTON AVE SUITE 200
TULSA OK
74127-9023
US

V. Phone/Fax

Practice location:
  • Phone: 701-952-4878
  • Fax: 701-952-3265
Mailing address:
  • Phone: 918-382-3178
  • Fax: 918-382-6789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number14684
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: