Provider Demographics
NPI:1326405085
Name:TAYLOR FAMILY CLINIC, PLLC
Entity Type:Organization
Organization Name:TAYLOR FAMILY CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DO
Authorized Official - Prefix:DR
Authorized Official - First Name:BEATRICE
Authorized Official - Middle Name:V
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:979-484-7120
Mailing Address - Street 1:657 E TRAVIS ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LA GRANGE
Mailing Address - State:TX
Mailing Address - Zip Code:78945-2302
Mailing Address - Country:US
Mailing Address - Phone:979-484-7120
Mailing Address - Fax:979-859-7121
Practice Address - Street 1:657 E TRAVIS ST
Practice Address - Street 2:STE A
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945-2302
Practice Address - Country:US
Practice Address - Phone:979-484-7120
Practice Address - Fax:979-859-7121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ2075208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX388381Medicare PIN