MEDICARE: MAYFIELD CLINIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207L00000X	Anesthesiology Physician
2	207LP2900X	Pain Medicine (Anesthesiology) Physician
3	208100000X	Physical Medicine & Rehabilitation Physician
4	2081P0004X	Spinal Cord Injury Medicine Physician
5	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician
6	225100000X	Physical Therapist
7	363A00000X	Physician Assistant
8	363AS0400X	Surgical Physician Assistant
9	363L00000X	Nurse Practitioner
10	363LA2100X	Acute Care Nurse Practitioner
11	207T00000X	Neurological Surgery Physician

General Provider Information

NPI Number	:	1073258968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAYFIELD CLINIC INC

Provider Business Mailing Address
First Line	:	PO BOX 643398
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45264-3398
Country	:	US
Telephone Number	:	513-221-1100
Fax Number	:	513-569-5297

Provider Business Practice Location Address
First Line	:	4020 SMITH RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45209-1936
Country	:	US
Telephone Number	:	513-221-1100
Fax Number	:	513-569-5297

Authorized Official
Title or Position	:	VP/CFO
Name	:	MICHAEL JAMES RADOMSKI
Credential	:
Telephone Number	:	513-569-5210

Provider Enumeration Date	:	05/04/2022
Last Update Date	:	05/04/2022

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Directions to “MAYFIELD CLINIC INC ” Practice Location

Language	Start Address	Practice Location

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