Brock A. Bailey, PA-C
Individual provider Active NPI Physician Assistant · Terre Haute, IN
NPI 1902340342 · NPPES record last updated Mar 9, 2023
Key facts
- NPI
- 1902340342
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 10002173A (IN)
- Practice address
- 3387 S US Highway 41
Terre Haute, IN 47802-4188 - Phone
- (812) 232-5532
- Fax
- (812) 232-2574
- NPI assigned
- Dec 4, 2016
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10002173A | IN | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Susan Koslow M.D.,Inc | Past |
Accepting new patients | |
| Major Hospital | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 10002173A | IN | Yes |
| Medical Physician Assistant | 363AM0700X |
Addresses
Primary practice location
3387 S US Highway 41
Terre Haute, IN 47802-4188
Mailing address
250 N Shadeland Ave
Suite 130 - Provider Enrollment
Indianapolis, IN 46219-4959
Phone (217) 246-9128
Other practice location 1
1606 N 7th St
Indianapolis, IN 47804-2706
Phone (812) 238-7523
Other providers in Terre Haute, IN
- B. & M. D Transportation LLC
- Jonah Backfish
- Emma Bacon
- Mohammed Hasan Badahman
- Baikal Surgical Specialists LLC
- Jessica Jane Bailey
- Brandi Leigh Baker
- Erica Lynn Baker
- Marisha Baker
- Tanya Michelle Baker
All providers in Terre Haute, IN · Physician Assistant in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 9, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.