Provider Demographics
NPI:1629303581
Name:TAYLOR MEDICAL ASSOCIATES P.C.
Entity Type:Organization
Organization Name:TAYLOR MEDICAL ASSOCIATES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BUYO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:570-562-0421
Mailing Address - Street 1:3 W OLIVE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-2572
Mailing Address - Country:US
Mailing Address - Phone:570-969-0663
Mailing Address - Fax:570-969-9697
Practice Address - Street 1:109 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:PA
Practice Address - Zip Code:18517-1415
Practice Address - Country:US
Practice Address - Phone:570-562-0421
Practice Address - Fax:570-986-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-11
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013728207Q00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025560600001Medicaid
PA169331Medicare PIN