Provider Demographics
NPI:1093490468
Name:TAYLOR, EDWARD
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 S KIEL ST
Mailing Address - Street 2:
Mailing Address - City:HOLSTEIN
Mailing Address - State:IA
Mailing Address - Zip Code:51025-5026
Mailing Address - Country:US
Mailing Address - Phone:712-368-6143
Mailing Address - Fax:712-368-6191
Practice Address - Street 1:609 S KIEL ST
Practice Address - Street 2:
Practice Address - City:HOLSTEIN
Practice Address - State:IA
Practice Address - Zip Code:51025-5026
Practice Address - Country:US
Practice Address - Phone:712-368-6143
Practice Address - Fax:712-368-6191
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)