Provider Demographics
NPI:1649523291
Name:ROLLAND L BAILEY DO PA
Entity type:Organization
Organization Name:ROLLAND L BAILEY DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLLAND
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:870-453-2266
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:FLIPPIN
Mailing Address - State:AR
Mailing Address - Zip Code:72634-0309
Mailing Address - Country:US
Mailing Address - Phone:870-453-2266
Mailing Address - Fax:870-453-7168
Practice Address - Street 1:806 E MAIN STREET
Practice Address - Street 2:
Practice Address - City:FLIPPIN
Practice Address - State:AR
Practice Address - Zip Code:72634
Practice Address - Country:US
Practice Address - Phone:870-453-2266
Practice Address - Fax:870-453-7168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-19
Last Update Date:2012-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN-6958207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty