Provider Demographics
NPI:1275738486
Name:BAILEY, JASON M (DO)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:M
Last Name:BAILEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1 MT. CARMEL WAY
Mailing Address - Street 2:2ND FLOOR, EAST
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-6620
Mailing Address - Country:US
Mailing Address - Phone:620-235-7655
Mailing Address - Fax:620-235-7659
Practice Address - Street 1:2900 MEDICAL CENTER PKWY STE 310
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3214
Practice Address - Country:US
Practice Address - Phone:479-553-3310
Practice Address - Fax:479-553-1945
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS05-36693207RC0200X, 207RP1001X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201086210AMedicaid
OK200508990AMedicaid