1417990094 NPI number — JAMES E TAYLOR MD

Table of content: JAMES E TAYLOR MD (NPI 1417990094)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417990094 NPI number — JAMES E TAYLOR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAYLOR
Provider First Name:
JAMES
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1417990094
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
695 S BENNETT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHERN PINES
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28387-5919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-725-1708
Provider Business Mailing Address Fax Number:
910-725-1718

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
165 TURNBERRY WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINEHURST
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28374-8509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-725-1708
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/13/2006

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: 207L00000X , with the licence number:  200100970 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1289K . This is a "NC BLUE CROSS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 891289K , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: NA . This is a "NA" identifier . This identifiers is of the category "OTHER".
  • Identifier: N00975 . This is a "SC MEDICAID" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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