Provider Demographics
NPI:1811186703
Name:MAYFIELD RADIOLOGISTS PSC
Entity Type:Organization
Organization Name:MAYFIELD RADIOLOGISTS PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-247-8710
Mailing Address - Street 1:132 ARBOR CREST DR
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-1233
Mailing Address - Country:US
Mailing Address - Phone:270-247-8710
Mailing Address - Fax:270-247-9564
Practice Address - Street 1:132 ARBOR CREST DR
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-1233
Practice Address - Country:US
Practice Address - Phone:270-247-8710
Practice Address - Fax:270-247-9564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY250792085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64250798Medicaid
KY000000059857OtherANTHEM BLUE CROSS BLUE SH
KY300011148OtherPALMETTO GBA MEDICARE
KY64250798Medicaid