Provider Demographics
NPI:1982854048
Name:BAILEY ANESTHESIA LLC
Entity Type:Organization
Organization Name:BAILEY ANESTHESIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:479-926-9089
Mailing Address - Street 1:PO BOX 10911
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72917-0911
Mailing Address - Country:US
Mailing Address - Phone:479-926-9089
Mailing Address - Fax:
Practice Address - Street 1:8200 MILE TREE DR
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-4373
Practice Address - Country:US
Practice Address - Phone:479-926-9089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-25
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR163947001Medicaid
AR5A131OtherBLUE CROSS/BLUE SHIELD OF AR
AR163947001Medicaid