Provider Demographics
NPI:1316534183
Name:BAILES, CARL EDWARD
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:EDWARD
Last Name:BAILES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 OLDAKER RD
Mailing Address - Street 2:
Mailing Address - City:LEON
Mailing Address - State:WV
Mailing Address - Zip Code:25123-6616
Mailing Address - Country:US
Mailing Address - Phone:304-549-3995
Mailing Address - Fax:
Practice Address - Street 1:1827 OLDAKER RD
Practice Address - Street 2:
Practice Address - City:LEON
Practice Address - State:WV
Practice Address - Zip Code:25123-6616
Practice Address - Country:US
Practice Address - Phone:304-549-3995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant