Provider Demographics
NPI:1316428121
Name:BAILEY'S EXECUTIVE MEDICAL TRANSPORTATION SERVICE LLC
Entity type:Organization
Organization Name:BAILEY'S EXECUTIVE MEDICAL TRANSPORTATION SERVICE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:L
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-362-6234
Mailing Address - Street 1:3239 TANSEL ROAD UNIT 34035
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234
Mailing Address - Country:US
Mailing Address - Phone:317-766-6908
Mailing Address - Fax:
Practice Address - Street 1:2715 BRIDGEMERRY LN
Practice Address - Street 2:
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-7200
Practice Address - Country:US
Practice Address - Phone:131-736-2623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1306356795Medicaid