1891787578 NPI number — MARK E TAYLOR MD

Table of content: MARK E TAYLOR MD (NPI 1891787578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891787578 NPI number — MARK E TAYLOR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAYLOR
Provider First Name:
MARK
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891787578
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 CLYBURN PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AIKEN
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29801-4193
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-380-7000
Provider Business Mailing Address Fax Number:
803-502-4248

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 CLYBURN PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AIKEN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29801-4193
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-380-7000
Provider Business Practice Location Address Fax Number:
803-502-4248
Provider Enumeration Date:
08/18/2005

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: 207Q00000X , with the licence number:  055797 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 37534 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 980939645C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000471809C , issued by the state of ( GU ) . This identifiers is of the category "MEDICAID".
  • Identifier: 341630 . This is a "WELLCARE MCAID" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 342410 . This is a "WELLCARE MCAID" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 341630 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 980939645E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 341628 . This is a "WELLCARE MCAID" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 341629 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 980939645G , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000471809A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10060509 . This is a "AMERIGROUP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 980939645F , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000467519A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000471809B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10060509 . This is a "AMERIGROUP MCAID" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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