Provider Demographics
NPI:1083863138
Name:THE TAYLOR GENESIS GROUP LLC
Entity Type:Organization
Organization Name:THE TAYLOR GENESIS GROUP LLC
Other - Org Name:T.G. TRANSPORTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:PHILANA
Authorized Official - Last Name:WILLIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-651-6213
Mailing Address - Street 1:7421 RICHARDSON HEIGHTS PL
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32209-1021
Mailing Address - Country:US
Mailing Address - Phone:904-651-6213
Mailing Address - Fax:
Practice Address - Street 1:7421 RICHARDSON HEIGHTS PL
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-1021
Practice Address - Country:US
Practice Address - Phone:904-651-6213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-13
Last Update Date:2008-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)