Provider Demographics
NPI:1902803182
Name:CITY OF MAYFIELD OFFICE OF CITY CLERK
Entity Type:Organization
Organization Name:CITY OF MAYFIELD OFFICE OF CITY CLERK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CREASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-251-6240
Mailing Address - Street 1:PO BOX 589
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-5011
Mailing Address - Country:US
Mailing Address - Phone:270-824-8123
Mailing Address - Fax:270-824-8140
Practice Address - Street 1:104 N 6TH ST
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-1602
Practice Address - Country:US
Practice Address - Phone:270-251-6248
Practice Address - Fax:270-251-9888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-04
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10093416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY56004286Medicaid
KY55042014Medicaid
406590071OtherRR MEDICARE
406590071OtherRR MEDICARE