NPIMap

Organization Active NPI

Taylor Regional Medical Group, LLC

  • Surgery Physician
  • Campbellsville, KY
National Provider Identifier
1326052002
Registry record updated May 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
TAYLOR REGIONAL MEDICAL GROUP, LLC
Practice address
1698 Old Lebanon Rd
Suite 2a
Campbellsville, KY 42718-9662
Phone
(270) 465-3561
Fax
(270) 789-6119
NPI assigned
Jul 28, 2006
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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X Primary
Medical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AM0700X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X KY

Addresses

Primary practice location

1698 Old Lebanon Rd
Suite 2a
Campbellsville, KY 42718-9662

Mailing address

1698 Old Lebanon Rd
Campbellsville, KY 42718-9662
Phone (270) 465-3561

Other practice location 1

215 N Depot St
Lebanon, KY 40033-1419
Phone (270) 789-0587

Other practice location 2

3066 Campbellsville Rd
Columbia, KY 42728-9511
Phone (270) 789-0587

Other identifiers 3

IdentifierTypeStateIssuer
7100428810MedicaidKY
65944449MedicaidKY
7100477070MedicaidKY

Other names 1

  • Taylor Regional Surgical Associates 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 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748304000000",
    "number": "1326052002",
    "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": "427189662",
            "telephone_number": "270-465-3561",
            "fax_number": "270-789-6119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1698 OLD LEBANON RD",
            "address_2": "SUITE 2A",
            "city": "CAMPBELLSVILLE",
            "state": "KY",
            "postal_code": "427189662",
            "telephone_number": "270-465-3561",
            "fax_number": "270-789-6119"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "215 N Depot St",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "KY",
            "postal_code": "400331419",
            "country_code": "US",
            "telephone_number": "270-789-0587",
            "fax_number": "270-789-1756",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3066 Campbellsville Rd",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "KY",
            "postal_code": "427289511",
            "country_code": "US",
            "telephone_number": "270-789-0587",
            "fax_number": "270-789-1756",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TAYLOR REGIONAL MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-28",
        "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": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100428810",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65944449",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100477070",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Taylor Regional Surgical Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Taylor Regional Surgical Associates",
            "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.