Provider Demographics
NPI:1265329767
Name:TAYLOR, THEODORE IV
Entity type:Individual
Prefix:
First Name:THEODORE
Middle Name:
Last Name:TAYLOR
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14105 JENNE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44110-2036
Mailing Address - Country:US
Mailing Address - Phone:216-688-5494
Mailing Address - Fax:
Practice Address - Street 1:14105 JENNE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44110-2036
Practice Address - Country:US
Practice Address - Phone:216-688-5494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)