1720413834 NPI number — TAYLORMADE LIFE RESOURCES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720413834 NPI number — TAYLORMADE LIFE RESOURCES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAYLORMADE LIFE RESOURCES
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:
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:
1720413834
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 W WALNUT HILL LN
Provider Second Line Business Mailing Address:
SUITE 3000
Provider Business Mailing Address City Name:
IRVING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75038-3029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-550-9095
Provider Business Mailing Address Fax Number:
866-463-3678

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 W WALNUT HILL LN
Provider Second Line Business Practice Location Address:
SUITE 3000
Provider Business Practice Location Address City Name:
IRVING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75038-3029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-550-9095
Provider Business Practice Location Address Fax Number:
866-463-3678
Provider Enumeration Date:
09/09/2013

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
DALE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
972-550-9095

Provider Taxonomy Codes

  • Taxonomy code: 251V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com