MEDICARE: VIRGINIA E. BAILEY IDMT

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	1710I1003X	Independent Duty Medical Technicians

General Provider Information

NPI Number	:	1063647196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGINIA E. BAILEY IDMT

Provider Business Mailing Address
First Line	:	4575 S. PHOENIX ST.
Second Line	:	563RD OSS/OSM DAVIS-MONTHAN AIR FORCE BASE
City	:	TUCSON
State	:	AZ
Zip	:	85707
Country	:	US
Telephone Number	:	520-228-1860
Fax Number	:

Provider Business Practice Location Address
First Line	:	4837 S PHOENIX ST.
Second Line	:	RM 119 DAVIS-MONTHAN AIR FORCE BASE
City	:	TUCSON
State	:	AZ
Zip	:	85707
Country	:	US
Telephone Number	:	520-228-1860
Fax Number	:

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

Provider Enumeration Date	:	05/19/2009
Last Update Date	:	05/19/2009

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