Provider Demographics
NPI:1437337342
Name:MARK C. BAYLOR, M.D.
Entity Type:Organization
Organization Name:MARK C. BAYLOR, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:BAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-742-2921
Mailing Address - Street 1:120 W MAIN ST
Mailing Address - Street 2:PO BOX 680
Mailing Address - City:ELMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:61529-9608
Mailing Address - Country:US
Mailing Address - Phone:309-742-2921
Mailing Address - Fax:309-742-8411
Practice Address - Street 1:120 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ELMWOOD
Practice Address - State:IL
Practice Address - Zip Code:61529-9608
Practice Address - Country:US
Practice Address - Phone:309-742-2921
Practice Address - Fax:309-742-8411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036069541207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7200613OtherBCBS OF ILLINOIS
ILCG6833OtherRR MEDICARE
IL198663OtherHEALTHLINK
IL198663OtherHEALTHLINK