Basic Information
| Provider Information | |||||||||
| NPI: | 1790041754 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TAYLOR REGIONAL RADIATION ONCOLOGY PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7240 SOLUTION CTR | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606777002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8663530360 | ||||||||
| FaxNumber: | 6152960952 | ||||||||
| Practice Location | |||||||||
| Address1: | 125 GREENBRIAR DR | ||||||||
| Address2: | |||||||||
| City: | CAMPBELLSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 427189616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2707899999 | ||||||||
| FaxNumber: | 2707890247 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2012 | ||||||||
| LastUpdateDate: | 04/04/2012 | ||||||||
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| AuthorizedOfficialLastName: | HARDIN | ||||||||
| AuthorizedOfficialFirstName: | PETER | ||||||||
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| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 2707899999 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.