Provider Demographics
NPI:1528037959
Name:BAILEY FAMILY PRACTICE CENTER, P.A.
Entity Type:Organization
Organization Name:BAILEY FAMILY PRACTICE CENTER, P.A.
Other - Org Name:FAMILY MEDICAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THEODORE
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:BRNA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:252-235-4181
Mailing Address - Street 1:6321 DEANS ST
Mailing Address - Street 2:P. O. BOX 280
Mailing Address - City:BAILEY
Mailing Address - State:NC
Mailing Address - Zip Code:27807-8641
Mailing Address - Country:US
Mailing Address - Phone:252-235-4181
Mailing Address - Fax:252-235-2950
Practice Address - Street 1:6321 DEANS ST
Practice Address - Street 2:
Practice Address - City:BAILEY
Practice Address - State:NC
Practice Address - Zip Code:27807-8641
Practice Address - Country:US
Practice Address - Phone:252-235-4181
Practice Address - Fax:252-235-2950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-16
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38590261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89159HMedicaid
NC0159HOtherBLUE CROSS
NC5610052OtherVIRIGINIA MEDICAID
NCCM4727OtherRAILROAD MEDICARE GROUP
NCCM4727OtherRAILROAD MEDICARE GROUP