1174768717 NPI number — TAYLOR REGIONAL MEDICAL GROUP LLC

Table of content: (NPI 1174768717)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174768717 NPI number — TAYLOR REGIONAL MEDICAL GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAYLOR REGIONAL MEDICAL GROUP LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TAYLOR REGIONAL PULMONOLOGY AND SLEEP MEDICINE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174768717
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
67 KINGSWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMPBELLSVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42718-9647
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-469-1400
Provider Business Mailing Address Fax Number:
270-789-5751

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
67 KINGSWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMPBELLSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42718-9647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-465-2116
Provider Business Practice Location Address Fax Number:
270-465-2126
Provider Enumeration Date:
12/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WALDRON
Authorized Official First Name:
DEBRA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
COORDINATOR
Authorized Official Telephone Number:
270-465-3561

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RS0012X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7100326410 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100069740 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com