Provider Demographics
NPI:1891204574
Name:TAYLORMADE HEALTH SOLUTIONS
Entity Type:Organization
Organization Name:TAYLORMADE HEALTH SOLUTIONS
Other - Org Name:JASPER COUNTY MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LEAD CONSULTANT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIETRICH
Authorized Official - Middle Name:T
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN,CDE
Authorized Official - Phone:601-502-5458
Mailing Address - Street 1:PO BOX 320301
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-0301
Mailing Address - Country:US
Mailing Address - Phone:601-502-5458
Mailing Address - Fax:877-534-9283
Practice Address - Street 1:306 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HEIDELBERG
Practice Address - State:MS
Practice Address - Zip Code:39439-3943
Practice Address - Country:US
Practice Address - Phone:601-502-5458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-25
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies