1114166139 NPI number — DR. WILLIAM RILEY TAYLOR WILLIAM TAYLOR

Table of content: DR. WILLIAM RILEY TAYLOR WILLIAM TAYLOR (NPI 1114166139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114166139 NPI number — DR. WILLIAM RILEY TAYLOR WILLIAM TAYLOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAYLOR
Provider First Name:
WILLIAM
Provider Middle Name:
RILEY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
WILLIAM TAYLOR
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TAYLOR
Provider Other First Name:
BILL
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1114166139
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1231
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAVRE
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59501-1231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-262-1305
Provider Business Mailing Address Fax Number:
406-265-1651

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1660 SPRINGHILL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36604-1405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-665-8000
Provider Business Practice Location Address Fax Number:
251-665-8010
Provider Enumeration Date:
02/14/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  8992 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 109946600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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