Organization
MAYFIELD RADIOLOGISTS PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHERRIE A BEASLEY (OFFICE MANAGER)
(270) 247-8710
Entity
Organization
Contact information
Practice address
132 ARBOR CREST DR, MAYFIELD, KY 42066-1233
(270) 247-8710
(270) 247-9564
Mailing address
132 ARBOR CREST DR, MAYFIELD, KY 42066-1233
(270) 247-8710
(270) 247-9564
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
25079
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000059857
ANTHEM BLUE CROSS BLUE SH
KY
01
—
300011148
PALMETTO GBA MEDICARE
KY
05
—
64250798
—
KY
Enumeration date
10/17/2007
Last updated
11/08/2011
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