MEDICARE: MAYBIRD MEDICAL, PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	208600000X	Surgery Physician
2	2086S0127X	Trauma Surgery Physician
3	224Z00000X	Occupational Therapy Assistant
4	225100000X	Physical Therapist
5	225200000X	Physical Therapy Assistant
6	225X00000X	Occupational Therapist
7	163W00000X	Registered Nurse
8	207X00000X	Orthopaedic Surgery Physician
9	207XS0117X	Orthopaedic Surgery of the Spine Physician
10	207T00000X	Neurological Surgery Physician
11	246ZC0007X	Surgical Assistant
12	363AM0700X	Medical Physician Assistant
13	363AS0400X	Surgical Physician Assistant
14	363L00000X	Nurse Practitioner
15	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1437854809
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAYBIRD MEDICAL, PLLC

Provider Business Mailing Address
First Line	:	7085 S WATERMILL CIR
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-4328
Country	:	US
Telephone Number	:	801-641-7473
Fax Number	:

Provider Business Practice Location Address
First Line	:	7085 S WATERMILL CIR
Second Line	:
City	:	COTTONWOOD HEIGHTS
State	:	UT
Zip	:	84121-4328
Country	:	US
Telephone Number	:	801-641-7473
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED AGENT
Name	:	JONATHAN MIDDLEMISS
Credential	:
Telephone Number	:	801-641-7473

Provider Enumeration Date	:	04/04/2023
Last Update Date	:	07/29/2023

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