Provider Demographics
| NPI: | 1073258968 |
|---|---|
| Name: | MAYFIELD CLINIC INC |
| Entity Type: | Organization |
| Organization Name: | MAYFIELD CLINIC INC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | VP/CFO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | MICHAEL |
| Authorized Official - Middle Name: | JAMES |
| Authorized Official - Last Name: | RADOMSKI |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 513-569-5210 |
| Mailing Address - Street 1: | PO BOX 643398 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | CINCINNATI |
| Mailing Address - State: | OH |
| Mailing Address - Zip Code: | 45264-3398 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 513-221-1100 |
| Mailing Address - Fax: | 513-569-5297 |
| Practice Address - Street 1: | 4020 SMITH RD |
| Practice Address - Street 2: | |
| Practice Address - City: | CINCINNATI |
| Practice Address - State: | OH |
| Practice Address - Zip Code: | 45209-1936 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 513-221-1100 |
| Practice Address - Fax: | 513-569-5297 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2022-05-04 |
| Last Update Date: | 2022-05-04 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
| No | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology | Group - Multi-Specialty | |
| No | 207LP2900X | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | Group - Multi-Specialty |
| No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
| No | 2081P0004X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Spinal Cord Injury Medicine | Group - Multi-Specialty |
| No | 2081P2900X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | Group - Multi-Specialty |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363AS0400X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | Group - Multi-Specialty |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
| No | 363LA2100X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | Group - Multi-Specialty |
