Provider Demographics
NPI:1124192604
Name:TAYLOR REGIONAL HOSPITAL
Entity Type:Organization
Organization Name:TAYLOR REGIONAL HOSPITAL
Other - Org Name:TAYLOR REGIONAL HOSPITAL EMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:G
Authorized Official - Last Name:HERNDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-783-0200
Mailing Address - Street 1:PO BOX 1297
Mailing Address - Street 2:
Mailing Address - City:HAWKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31036-7297
Mailing Address - Country:US
Mailing Address - Phone:478-783-0200
Mailing Address - Fax:478-892-0518
Practice Address - Street 1:222 PERRY HWY
Practice Address - Street 2:
Practice Address - City:HAWKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31036-6748
Practice Address - Country:US
Practice Address - Phone:478-783-0200
Practice Address - Fax:478-783-2731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA116-05341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000001548CMedicaid
GAHOSP27Medicare PIN
GA110135Medicare UPIN