Provider Demographics
NPI:1114013315
Name:TAYLOR INTERNAL MEDICINE OF SELMA, P.C.
Entity Type:Organization
Organization Name:TAYLOR INTERNAL MEDICINE OF SELMA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-874-8800
Mailing Address - Street 1:4258 US HIGHWAY 80 W
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701-2202
Mailing Address - Country:US
Mailing Address - Phone:334-874-8800
Mailing Address - Fax:334-874-7700
Practice Address - Street 1:4258 US HIGHWAY 80 W
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-2202
Practice Address - Country:US
Practice Address - Phone:334-874-8800
Practice Address - Fax:334-874-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL24464174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529916810Medicaid
AL529916810Medicaid
ALK560Medicare ID - Type Unspecified
AL5620230001Medicare NSC