Provider Demographics
NPI:1255814562
Name:MEIBOS, BAILEY
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:
Last Name:MEIBOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5539
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59604-5539
Mailing Address - Country:US
Mailing Address - Phone:406-444-7500
Mailing Address - Fax:
Practice Address - Street 1:2620 SHODAIR DR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-5743
Practice Address - Country:US
Practice Address - Phone:406-444-7500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTGEN-GEN-LIC-001067170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000055266OtherMEDICARE PIN
UT8760003008007Medicaid
UT260022408OtherRAILROAD MEDICARE