Provider Demographics
NPI:1376754861
Name:TAYLOR REGIONAL HOSPITAL URGENT CARE CENTER, LLC
Entity Type:Organization
Organization Name:TAYLOR REGIONAL HOSPITAL URGENT CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UCC DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MATILDA
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-932-2221
Mailing Address - Street 1:1911 CAMPBELLSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:42743-7758
Mailing Address - Country:US
Mailing Address - Phone:270-932-2221
Mailing Address - Fax:270-932-2201
Practice Address - Street 1:1911 CAMPBELLSVILLE RD
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:KY
Practice Address - Zip Code:42743-7758
Practice Address - Country:US
Practice Address - Phone:270-932-2221
Practice Address - Fax:270-932-2201
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAYLOR REGIONAL HOSPITAL URGENT CARE CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-25
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100011450Medicaid
KY000000526336OtherANTHEM
KY78010741Medicaid
KY7100006720Medicaid
KYQ04044Medicare UPIN
KY78010741Medicaid