Provider Demographics
NPI:1174852461
Name:MAYFIELD SPINE SURGERY CENTER LLC
Entity Type:Organization
Organization Name:MAYFIELD SPINE SURGERY CENTER LLC
Other - Org Name:MAYFIELD SPINE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICCER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GALVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-706-8334
Mailing Address - Street 1:4020 SMITH RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-1936
Mailing Address - Country:US
Mailing Address - Phone:513-619-5899
Mailing Address - Fax:513-619-5897
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:513-619-5899
Practice Address - Fax:513-619-5897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-15
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0834AS261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00937770OtherRAILROAD MEDICARE
OH3125424Medicaid
OH3612222Medicare PIN