Provider Demographics
NPI:1659622553
Name:MAXFIELD ENTERPRISE
Entity Type:Organization
Organization Name:MAXFIELD ENTERPRISE
Other - Org Name:MTCAM
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAXFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-957-2057
Mailing Address - Street 1:7123 CROSSROADS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-2877
Mailing Address - Country:US
Mailing Address - Phone:615-656-3558
Mailing Address - Fax:
Practice Address - Street 1:7123 CROSSROADS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-2877
Practice Address - Country:US
Practice Address - Phone:615-656-3558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2625302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization