Provider Demographics
NPI:1194962191
Name:MICHAEL L. BAILEY, D.O., P.A.
Entity type:Organization
Organization Name:MICHAEL L. BAILEY, D.O., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-562-2339
Mailing Address - Street 1:3418 N TARRANT PKWY STE 310
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-8645
Mailing Address - Country:US
Mailing Address - Phone:817-562-2339
Mailing Address - Fax:817-562-1342
Practice Address - Street 1:3418 N TARRANT PKWY STE 310
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-8645
Practice Address - Country:US
Practice Address - Phone:817-562-2339
Practice Address - Fax:817-562-1342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-13
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
TXK5446261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201660202Medicaid
TX130929605Medicaid
TX201660201Medicaid
TXOA3624Medicare UPIN
TX130929605Medicaid