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NPI Code Detail

MEDICARE: MR. RICHARD A BAILEY JR. PA-C

MEDICARE: MR. RICHARD A BAILEY JR. PA-C
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
1363A00000XPhysician Assistant50002410OH

General Provider Information

NPI Number : 1548239791
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RICHARD A BAILEY JR. PA-C
Provider Business Mailing Address
First Line : 315 STRUTHERS LIBERTY RD
Second Line :
City : CAMPBELL
State : OH
Zip : 44405-1973
Country : US
Telephone Number : 330-750-1333
Fax Number : 330-750-0203
Provider Business Practice Location Address
First Line : 315 STRUTHERS LIBERTY RD
Second Line :
City : CAMPBELL
State : OH
Zip : 44405-1949
Country : US
Telephone Number : 330-750-1333
Fax Number : 330-750-0203
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2006
Last Update Date : 01/19/2010

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