Provider Demographics
NPI:1396896577
Name:BAILEY, MATTHEW KEITH (MD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:KEITH
Last Name:BAILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SUNNYVIEW LN
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3164
Mailing Address - Country:US
Mailing Address - Phone:406-752-7900
Mailing Address - Fax:406-257-0253
Practice Address - Street 1:111 SUNNYVIEW LN
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3164
Practice Address - Country:US
Practice Address - Phone:406-752-7900
Practice Address - Fax:406-257-0253
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10135174400000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0089641Medicaid
MT1396896577OtherBLUE CROSS BLUE SHIELD
MT000084394Medicare PIN
MT1396896577OtherBLUE CROSS BLUE SHIELD
MT000084394Medicare ID - Type Unspecified
MT011001674Medicare PIN
MTP00181587Medicare PIN