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NPI Code Detail

MEDICARE: SAMUEL A BAILEY PA

MEDICARE: SAMUEL A BAILEY PA
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 Assistant85001646IL
2207P00000XEmergency Medicine Physician085-001646IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1085001646OTHERILBLUE SHIELD

General Provider Information

NPI Number : 1891778254
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAMUEL A BAILEY PA
Provider Business Mailing Address
First Line : PO BOX 66971
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63166-6971
Country : US
Telephone Number : 800-968-6866
Fax Number :
Provider Business Practice Location Address
First Line : 6800 STATE ROUTE 162
Second Line :
City : MARYVILLE
State : IL
Zip : 62062-8500
Country : US
Telephone Number : 800-968-6866
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2005
Last Update Date : 04/24/2008

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Directions to “ SAMUEL A BAILEY PA” Practice Location

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