MEDICARE: TAYLOR RUGG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	4703121445	MI

General Provider Information

NPI Number	:	1003593823
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAYLOR RUGG

Provider Business Mailing Address
First Line	:	249 BEAUMONT DR
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49014-8275
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	249 BEAUMONT DR
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49014-8275
Country	:	US
Telephone Number	:	269-986-8709
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2023
Last Update Date	:	07/03/2023

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