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General NPI Number Information
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NPI Number | 1174768717
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Entity Type | Organization
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Legal Business Name | TAYLOR REGIONAL MEDICAL GROUP LLC
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Dates
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Enumeration Date | 12/11/2008
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 67 KINGSWOOD DR
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City | CAMPBELLSVILLE
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State | KY
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Zip | 42718-9647
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Country | US
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Telephone | 270-465-2116
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Fax | 270-465-2126
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Provider Business Mailing Address
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Address Line | 67 KINGSWOOD DR
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City | CAMPBELLSVILLE
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State | KY
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Zip | 42718-9647
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Country | US
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Telephone | 270-469-1400
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Fax | 270-789-5751
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Authorized Official
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Title or Position | COORDINATOR
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Name | DEBRA ANN WALDRON
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Credential |
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Telephone | 270-465-3561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State |
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