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General NPI Number Information
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NPI Number | 1205079134
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Entity Type | Organization
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Legal Business Name | MAYFIELD PEDIATRIC CLINIC PLLC
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Dates
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Enumeration Date | 04/07/2009
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 417 S 6TH ST
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City | MAYFIELD
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State | KY
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Zip | 42066
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Country | US
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Telephone | 270-247-1104
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Fax | 270-247-1107
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Provider Business Mailing Address
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Address Line | 417 S. 6TH ST.
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City | MAYFIELD
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State | KY
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Zip | 42066
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Country | US
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Telephone | 270-247-1104
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Fax | 270-247-1107
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Authorized Official
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Title or Position | OWNER
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Name | ABID HUSSAIN
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Credential | M.D.
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Telephone | 270-247-1104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 41115
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 41115
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 41115
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License Number State | KY
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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