Provider Demographics
NPI:1447581871
Name:TAYLOR RURAL HEALTH, LLC
Entity Type:Organization
Organization Name:TAYLOR RURAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEATLEY
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE
Authorized Official - Phone:270-465-3561
Mailing Address - Street 1:805 BURKESVILLE ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-1655
Mailing Address - Country:US
Mailing Address - Phone:270-384-1110
Mailing Address - Fax:270-384-3436
Practice Address - Street 1:805 BURKESVILLE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:KY
Practice Address - Zip Code:42728-1655
Practice Address - Country:US
Practice Address - Phone:270-384-1110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAYLOR REGIONAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-25
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY900046261QP2300X
KY261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100127170Medicaid