# SUSAN R. BAILEY, M.D.P.A.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184886640
- **Authorized official:** ELLEN ROGERS (INSURANCE SUPERVISOR)
- **Authorized official phone:** (817) 315-2550

## Contact information

- **Practice address:** 5929 LOVELL AVE, FORT WORTH, TX 76107-5029
- **Practice address phone:** (817) 315-2550
- **Practice address fax:** (817) 732-4660
- **Mailing address:** 5929 LOVELL AVE, FORT WORTH, TX 76107-5029
- **Mailing address phone:** (817) 315-2550
- **Mailing address fax:** (817) 732-4660

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | G0037 | TX | Yes |

## Other

- **Enumeration date:** 06/26/2008
- **Last updated:** 12/31/2008