Provider Demographics
NPI:1720376411
Name:TAYLOR REGIONAL MEDICAL GROUP,LLC
Entity Type:Organization
Organization Name:TAYLOR REGIONAL MEDICAL GROUP,LLC
Other - Org Name:TAYLOR REGIONAL PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSENGALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-465-3561
Mailing Address - Street 1:1698 OLD LEBANON RD
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-9662
Mailing Address - Country:US
Mailing Address - Phone:270-789-0587
Mailing Address - Fax:
Practice Address - Street 1:1698 OLD LEBANON RD
Practice Address - Street 2:SUITE 2A
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-9662
Practice Address - Country:US
Practice Address - Phone:270-789-6116
Practice Address - Fax:270-789-6119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-14
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty