Provider Demographics
NPI:1639455280
Name:SUMMERS W. TAYLOR, III, MD, PC
Entity Type:Organization
Organization Name:SUMMERS W. TAYLOR, III, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:SUMMERS
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:256-840-4530
Mailing Address - Street 1:2505 US HIGHWAY 431
Mailing Address - Street 2:WOMEN'S CENTER, SUITE A
Mailing Address - City:BOAZ
Mailing Address - State:AL
Mailing Address - Zip Code:35957-5908
Mailing Address - Country:US
Mailing Address - Phone:256-840-4430
Mailing Address - Fax:256-840-4537
Practice Address - Street 1:2505 US HIGHWAY 431
Practice Address - Street 2:WOMEN'S CENTER, SUITE A
Practice Address - City:BOAZ
Practice Address - State:AL
Practice Address - Zip Code:35957-5908
Practice Address - Country:US
Practice Address - Phone:256-840-4430
Practice Address - Fax:256-840-4537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-27
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13084207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009967600Medicaid
AL51504213OtherBLUE CROSS BLUE SHIELD
AL51504213Medicare PIN
AL009967600Medicaid