MEDICARE: BAILEY ANESTHESIA LLC

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	367500000X	Certified Registered Nurse Anesthetist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5A131	OTHER	AR	BLUE CROSS/BLUE SHIELD OF AR

General Provider Information

NPI Number	:	1982854048
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAILEY ANESTHESIA LLC

Provider Business Mailing Address
First Line	:	PO BOX 10911
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72917-0911
Country	:	US
Telephone Number	:	479-926-9089
Fax Number	:

Provider Business Practice Location Address
First Line	:	8200 MILE TREE DR
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-4373
Country	:	US
Telephone Number	:	479-926-9089
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KRISTOPHER A BAILEY
Credential	:	CRNA
Telephone Number	:	479-926-9089

Provider Enumeration Date	:	09/25/2008
Last Update Date	:	03/10/2017

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Directions to “BAILEY ANESTHESIA LLC ” Practice Location

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