Provider Demographics
NPI:1669514626
Name:MAYFIELD INDEPENDENT SCHOOLS
Entity type:Organization
Organization Name:MAYFIELD INDEPENDENT SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BURGETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-247-3868
Mailing Address - Street 1:914 E COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-2822
Mailing Address - Country:US
Mailing Address - Phone:270-247-3868
Mailing Address - Fax:270-247-3854
Practice Address - Street 1:914 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-2822
Practice Address - Country:US
Practice Address - Phone:270-247-3868
Practice Address - Fax:270-247-3854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY21042023Medicaid