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General NPI Number Information
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NPI Number | 1205017464
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Entity Type | Organization
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Legal Business Name | TAYLOR REGIONAL MEDICAL GROUP
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Dates
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Enumeration Date | 11/16/2007
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 125 GREENBRIAR DR
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City | CAMPBELLSVILLE
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State | KY
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Zip | 42718-9616
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Country | US
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Telephone | 270-789-6166
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Fax | 270-789-6198
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Provider Business Mailing Address
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Address Line | 1698 OLD LEBANON RD
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City | CAMPBELLSVILLE
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State | KY
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Zip | 42718-9662
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Country | US
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Telephone | 270-789-6087
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Fax |
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Authorized Official
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Title or Position | COORDINATOR
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Name | DEBRA 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 | 2085R0001X
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Taxonomy Name | Radiation Oncology 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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State | KY
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