Basic Information
| Provider Information | |||||||||
| NPI: | 1861409252 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | GARRETT | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5045 | ||||||||
| Address2: | ATTN: PROV ENROLLMENT, P.F.S. | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571175045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053222000 | ||||||||
| FaxNumber: | 6053222036 | ||||||||
| Practice Location | |||||||||
| Address1: | 1325 S CLIFF AVE | ||||||||
| Address2: | |||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571051007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6053222000 | ||||||||
| FaxNumber: | 6053222036 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 06/07/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 5195 | SD | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 106K1TA | 01 | MN | MN BC PROVIDER # | OTHER | 6004660 | 05 | SD | MEDICAID | 1550228 | 05 | IA | MEDICAID | 607620300 | 05 | MN | MEDICAID | P00920439 | 01 | SD | RAILROAD MEDICARE | OTHER | 9216564 | 01 | SC | DAKOTACARE PROVIDER # | OTHER | 0041368 | 01 | SD | SDBC P ROVIDER # | OTHER | 46022474331 | 05 | NE | MEDICAID | P00046387 | 01 | SD | RR MEDICARE PROVIDER # | OTHER |