1932590692 NPI number — DR. TAYLOR CAVANAUGH ST. AMOUR MD

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 1932590692 NPI number — DR. TAYLOR CAVANAUGH ST. AMOUR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ST. AMOUR
Provider First Name:
TAYLOR
Provider Middle Name:
CAVANAUGH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SUTCLIFFE
Provider Other First Name:
TAYLOR
Provider Other Middle Name:
CAVANAUGH
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1932590692
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1161 21ST AVENUE SOUTH
Provider Second Line Business Mailing Address:
D-4316 MEDICAL CENTER NORTH
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37232-3017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-322-2363
Provider Business Mailing Address Fax Number:
615-343-5365

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1161 21ST AVENUE SOUTH
Provider Second Line Business Practice Location Address:
D-4316 MEDICAL CENTER NORTH
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-322-2363
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/16/2015

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: 208600000X , with the licence number:  64168 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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