1760709893 NPI number — TAYLOR INTERNAL MEDICINE OF MOBILE

Table of content: (NPI 1760709893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760709893 NPI number — TAYLOR INTERNAL MEDICINE OF MOBILE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TAYLOR INTERNAL MEDICINE OF MOBILE
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:
1760709893
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4258 U.S. HWY. 80 WEST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SELMA
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36701-6949
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-874-8800
Provider Business Mailing Address Fax Number:
334-874-7700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18 C M RAMBO DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARALAND
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-679-0205
Provider Business Practice Location Address Fax Number:
251-679-0889
Provider Enumeration Date:
04/29/2010

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
BRUCE
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
334-874-8800

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  24464 , 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)





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