Provider Demographics
NPI:1730223561
Name:JEFFREY D BAILEY, INC.
Entity type:Organization
Organization Name:JEFFREY D BAILEY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:440-257-6752
Mailing Address - Street 1:5315 LENORE DR
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-1650
Mailing Address - Country:US
Mailing Address - Phone:440-257-6752
Mailing Address - Fax:216-928-0141
Practice Address - Street 1:5315 LENORE DR
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-1650
Practice Address - Country:US
Practice Address - Phone:440-257-6752
Practice Address - Fax:216-928-0141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH036424367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0918672Medicaid
OH280601212-00OtherOHO BWC#
OH280601212-00OtherOHO BWC#