Provider Demographics
NPI:1447040928
Name:THE TAYO CLINIC, INC.
Entity type:Organization
Organization Name:THE TAYO CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:PINA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MED
Authorized Official - Phone:920-267-5576
Mailing Address - Street 1:4321 W COLLEGE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54914-3968
Mailing Address - Country:US
Mailing Address - Phone:920-267-5576
Mailing Address - Fax:812-203-5057
Practice Address - Street 1:325 3RD ST
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-2712
Practice Address - Country:US
Practice Address - Phone:920-267-5576
Practice Address - Fax:812-203-5057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty