Taylor Clinton Marcum

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6500 Issued in OK

Practice address

5691 Tinker Diagonal
Midwest City, OK 73110-2821

Phone

(405) 737-5123

NPI assigned

May 23, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 28, 2016 through Apr 28, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Brandon E Beaver DDS PC

  • Dentist
  • Durant, OK
  • NPI 1174741474
  NPD (past)
• Dental Depot Mid West City

  • General Practice Dentistry
  • Midwest City, OK
  • NPI 1245434166
  NPD (past)

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

{
    "created_epoch": "1369267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369267200000",
    "number": "1740627272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 NE 53RD ST",
            "address_2": "APT 1919",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731051840",
            "telephone_number": "580-380-8315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5691 TINKER DIAGONAL",
            "city": "MIDWEST CITY",
            "state": "OK",
            "postal_code": "731102821",
            "telephone_number": "405-737-5123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARCUM",
        "first_name": "TAYLOR",
        "middle_name": "CLINTON",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-23",
        "last_updated": "2013-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "6500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Theodis Roosevelt Manning, B.S. ENGINEERING
• Manor Care of Midwest City Ok LLC
• Benjamin Panagiotis Mansalis, M.D.
• Jenell Mapp
• Makenna Marchbanks
• Terri Lynn Marino, L.P.C.
• Mark'S Prescription Shop Inc
• Melohdee Marroquin
• Chana Davi Martin, B.S.,C-RSS
• Denielle Martin

• General Practice Dentistry in Midwest City, OK
• Providers in Midwest City, OK by specialty
• General Practice Dentistry in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.