Provider Demographics
NPI:1811180623
Name:TAYLOR AND BALL ORTHOPEDIC CLINIC PA
Entity type:Organization
Organization Name:TAYLOR AND BALL ORTHOPEDIC CLINIC PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:E
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-442-4893
Mailing Address - Street 1:151 JEFFERSON DAVIS BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-5140
Mailing Address - Country:US
Mailing Address - Phone:601-442-4893
Mailing Address - Fax:601-442-0490
Practice Address - Street 1:151 JEFFERSON DAVIS BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-5140
Practice Address - Country:US
Practice Address - Phone:601-442-4893
Practice Address - Fax:601-442-0490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-24
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS05757207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00012274Medicaid
MSC00409Medicare PIN