Provider Demographics
NPI:1871693663
Name:RICHARD BAILEY M.D. MEDICAL PRACTICE, LLC
Entity type:Organization
Organization Name:RICHARD BAILEY M.D. MEDICAL PRACTICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-725-8350
Mailing Address - Street 1:975 HOPKINSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42276-9774
Mailing Address - Country:US
Mailing Address - Phone:270-725-8350
Mailing Address - Fax:270-725-8891
Practice Address - Street 1:975 HOPKINSVILLE RD
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-9774
Practice Address - Country:US
Practice Address - Phone:270-725-8350
Practice Address - Fax:270-725-8891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38418207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000316055OtherANTHEM
KY64079056Medicaid
KY000000316055OtherANTHEM
KY0901501Medicare ID - Type Unspecified
KY64079056Medicaid