Provider Demographics
NPI:1619581808
Name:RUSSELL TAYLOR GROUP LLC
Entity Type:Organization
Organization Name:RUSSELL TAYLOR GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCURDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-294-6487
Mailing Address - Street 1:2908 NW 130TH AVE APT 108
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-3055
Mailing Address - Country:US
Mailing Address - Phone:773-294-6487
Mailing Address - Fax:
Practice Address - Street 1:2908 NW 130TH AVE APT 108
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-3055
Practice Address - Country:US
Practice Address - Phone:773-294-6487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-03
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies