Provider Demographics
NPI:1821381245
Name:BAILEY, JAMES HARRISON ANDREW (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:HARRISON ANDREW
Last Name:BAILEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:DREW
Other - Middle Name:
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1101 SAINT CHRISTOPHER DR
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7087
Mailing Address - Country:US
Mailing Address - Phone:606-836-3196
Mailing Address - Fax:606-836-2564
Practice Address - Street 1:1101 SAINT CHRISTOPHER DR
Practice Address - Street 2:SUITE 250
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7087
Practice Address - Country:US
Practice Address - Phone:606-836-3196
Practice Address - Fax:606-836-2564
Is Sole Proprietor?:No
Enumeration Date:2011-05-18
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2700207Q00000X
KY03520207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100253600Medicaid
OH0086368Medicaid
WV3810026207Medicaid
WV3810026207Medicaid
WVWV3144B674Medicare PIN
WVWV3144CMedicare PIN
WVWV3144HMedicare PIN
WVWV3144AMedicare PIN
OH0086368Medicaid
WVWV3144BMedicare PIN
KY7100253600Medicaid
WV3144HMedicare PIN
WVWV3144GMedicare PIN
KYK119340Medicare PIN