Provider Demographics
NPI:1083044325
Name:MAYFIELD INC.
Entity Type:Organization
Organization Name:MAYFIELD INC.
Other - Org Name:FASTSERV MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-396-3366
Mailing Address - Street 1:112 SUMMER LN
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-3500
Mailing Address - Country:US
Mailing Address - Phone:318-396-3366
Mailing Address - Fax:318-397-2132
Practice Address - Street 1:1329 DRIFTWOOD DR
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2840
Practice Address - Country:US
Practice Address - Phone:318-741-9586
Practice Address - Fax:318-741-9587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-23
Last Update Date:2013-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment