Provider Demographics
NPI:1760709893
Name:TAYLOR INTERNAL MEDICINE OF MOBILE
Entity Type:Organization
Organization Name:TAYLOR INTERNAL MEDICINE OF MOBILE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-874-8800
Mailing Address - Street 1:4258 U.S. HWY. 80 WEST
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701-6949
Mailing Address - Country:US
Mailing Address - Phone:334-874-8800
Mailing Address - Fax:334-874-7700
Practice Address - Street 1:18 C M RAMBO DRIVE
Practice Address - Street 2:
Practice Address - City:SARALAND
Practice Address - State:AL
Practice Address - Zip Code:36571
Practice Address - Country:US
Practice Address - Phone:251-679-0205
Practice Address - Fax:251-679-0889
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAYLOR INTERNAL MEDICINE OF SELMA, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL24464332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL5620230001Medicare NSC