Healthcare Provider Details

I. General information

NPI: 1902803182
Provider Name (Legal Business Name): CITY OF MAYFIELD OFFICE OF CITY CLERK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2005
Last Update Date: 02/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 N 6TH ST
MAYFIELD KY
42066-1602
US

IV. Provider business mailing address

PO BOX 589
MADISONVILLE KY
42431-5011
US

V. Phone/Fax

Practice location:
  • Phone: 270-251-6248
  • Fax: 270-251-9888
Mailing address:
  • Phone: 270-824-8123
  • Fax: 270-824-8140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1009
License Number StateKY

VIII. Authorized Official

Name: JEREMY CREASON
Title or Position: DIRECTOR
Credential:
Phone: 270-251-6240