Provider Demographics
NPI:1245317593
Name:MAYFIELD INC.
Entity type:Organization
Organization Name:MAYFIELD INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
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 1:112 SUMMER LN
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-3500
Practice Address - Country:US
Practice Address - Phone:318-396-3366
Practice Address - Fax:318-397-2132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1548561Medicaid
LA1532622Medicaid
LA1548553Medicaid
LA1548561Medicaid
LA1532622Medicaid