Individual
SAMUEL A BAILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
6800 STATE ROUTE 162, MARYVILLE, IL 62062-8500
(800) 968-6866
Mailing address
PO BOX 66971, SAINT LOUIS, MO 63166-6971
(800) 968-6866
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
085-001646
IL
363A00000X
Physician Assistant
Primary
85001646
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
085001646
BLUE SHIELD
IL
Enumeration date
11/21/2005
Last updated
04/24/2008
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