Provider Demographics
NPI:1063647196
Name:BAILEY, VIRGINIA E (IDMT)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:E
Last Name:BAILEY
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4575 S. PHOENIX ST.
Mailing Address - Street 2:563RD OSS/OSM DAVIS-MONTHAN AIR FORCE BASE
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85707
Mailing Address - Country:US
Mailing Address - Phone:520-228-1860
Mailing Address - Fax:
Practice Address - Street 1:4837 S PHOENIX ST.
Practice Address - Street 2:RM 119 DAVIS-MONTHAN AIR FORCE BASE
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85707
Practice Address - Country:US
Practice Address - Phone:520-228-1860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians