Healthcare Provider Details

I. General information

NPI: 1124119763
Provider Name (Legal Business Name): DOUG TAYLOR PROSTHETICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 MAIN STREET
BEECH GROVE IN
46107-1814
US

IV. Provider business mailing address

207 MAIN STREET
BEECH GROVE IN
46107-1814
US

V. Phone/Fax

Practice location:
  • Phone: 317-782-9310
  • Fax: 317-782-9312
Mailing address:
  • Phone: 317-782-9310
  • Fax: 317-782-9312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberCP001415
License Number StateIN

VIII. Authorized Official

Name: MRS. MEGAN R MARSCHAND
Title or Position: OFFICE MANAGER
Credential:
Phone: 317-782-9310