Provider Demographics
NPI:1275004087
Name:RUTH TAGGART, LLC
Entity Type:Organization
Organization Name:RUTH TAGGART, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:C
Authorized Official - Last Name:TAGGART
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:303-968-4260
Mailing Address - Street 1:719 PARIS AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-3241
Mailing Address - Country:US
Mailing Address - Phone:303-968-4260
Mailing Address - Fax:
Practice Address - Street 1:719 PARIS AVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-3241
Practice Address - Country:US
Practice Address - Phone:303-968-4260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-06
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty