NPIMap

Organization Active NPI

Taylor Regional Medical Group LLC

Doing business as Taylor Regional ENT

  • Otolaryngology Physician
  • Campbellsville, KY
National Provider Identifier
1073817581
Registry record updated May 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
TAYLOR REGIONAL MEDICAL GROUP LLC
Doing business as
Taylor Regional ENT
Practice address
105 Greenbriar Dr
Suite a
Campbellsville, KY 42718-9617
Phone
(270) 465-3595
Fax
(270) 789-2044
NPI assigned
Dec 28, 2010
Last updated
May 27, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 27, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Debra Ann Waldron
Title
Coordinator
Phone
(270) 465-3561

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X NU
Nurse Practitioner 363L00000X NU
Family Nurse Practitioner 363LF0000X NU
Otolaryngology Physician 207Y00000X NU Primary
Audiologist-Hearing Aid Fitter 237600000X NU

Addresses

Primary practice location

105 Greenbriar Dr
Suite a
Campbellsville, KY 42718-9617

Mailing address

1698 Old Lebanon Rd
Campbellsville, KY 42718-3319
Phone (270) 789-6087

Other practice location 1

215 N Depot St
Lebanon, KY 40033-1419
Phone (270) 789-3595

Other practice location 2

187 Will Walker Rd
Columbia, KY 42728-7436
Phone (270) 465-3595

Other identifiers 3

IdentifierTypeStateIssuer
7100149690MedicaidKY
7100311680MedicaidKY
7100157910MedicaidKY

Other names 1

  • Taylor Regional ENT Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051221000527 KY Part B Supplier - Clinic/Group Practice 4880616622 Receives reassigned benefits from 89 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Columbia, KY; Campbellsville, KY; Lebanon, KY; Greensburg, KY; Caompbellsville, KY

Other NPIs on the same Medicare enrollment 15

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 15

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1293494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748304000000",
    "number": "1073817581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1698 OLD LEBANON RD",
            "city": "CAMPBELLSVILLE",
            "state": "KY",
            "postal_code": "427183319",
            "telephone_number": "270-789-6087",
            "fax_number": "270-789-6119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 GREENBRIAR DR",
            "address_2": "SUITE A",
            "city": "CAMPBELLSVILLE",
            "state": "KY",
            "postal_code": "427189617",
            "telephone_number": "270-465-3595",
            "fax_number": "270-789-2044"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "215 N Depot St",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "KY",
            "postal_code": "400331419",
            "country_code": "US",
            "telephone_number": "270-789-3595",
            "fax_number": "270-789-2044",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "187 Will Walker Rd",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "KY",
            "postal_code": "427287436",
            "country_code": "US",
            "telephone_number": "270-465-3595",
            "fax_number": "270-789-2044",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TAYLOR REGIONAL MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-28",
        "last_updated": "2025-05-27",
        "certification_date": "2025-05-27",
        "status": "A",
        "authorized_official_last_name": "WALDRON",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "COORDINATOR",
        "authorized_official_telephone_number": "270-465-3561"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "237600000X",
            "taxonomy_group": "",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100149690",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100311680",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100157910",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Taylor Regional ENT",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Taylor Regional ENT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Campbellsville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.