Provider Demographics
NPI:1902986011
Name:LISA BAILEY, MD, LLC
Entity Type:Organization
Organization Name:LISA BAILEY, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-482-9492
Mailing Address - Street 1:565 A ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2063
Mailing Address - Country:US
Mailing Address - Phone:541-482-9492
Mailing Address - Fax:541-482-9485
Practice Address - Street 1:565 A ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2063
Practice Address - Country:US
Practice Address - Phone:541-482-9492
Practice Address - Fax:541-482-9485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD204572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F22493Medicare UPIN
OR130022Medicare ID - Type Unspecified