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General NPI Number Information
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NPI Number | 1811186703
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Entity Type | Organization
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Legal Business Name | MAYFIELD RADIOLOGISTS PSC
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Dates
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Enumeration Date | 10/17/2007
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Last Update Date | 11/08/2011
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Provider Practice Location Address
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Address Line | 132 ARBOR CREST DR
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City | MAYFIELD
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State | KY
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Zip | 42066-1233
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Country | US
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Telephone | 270-247-8710
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Fax | 270-247-9564
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Provider Business Mailing Address
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Address Line | 132 ARBOR CREST DR
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City | MAYFIELD
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State | KY
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Zip | 42066-1233
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Country | US
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Telephone | 270-247-8710
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Fax | 270-247-9564
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. SHERRIE A BEASLEY
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Credential |
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Telephone | 270-247-8710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 25079
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License Number State | KY
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