Provider Demographics
NPI:1073282513
Name:TAYLOR MADE CLINIC, PLLC
Entity type:Organization
Organization Name:TAYLOR MADE CLINIC, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CALLIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:870-269-8700
Mailing Address - Street 1:316 E MAIN ST
Mailing Address - Street 2:PO BOX 312
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:AR
Mailing Address - Zip Code:72560-0316
Mailing Address - Country:US
Mailing Address - Phone:870-269-8700
Mailing Address - Fax:
Practice Address - Street 1:316 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:AR
Practice Address - Zip Code:72560-0316
Practice Address - Country:US
Practice Address - Phone:870-269-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-08
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty