| Mayfield Advanced Medical, Llc | |
|
5419 Jackson St Ext Ste B Alexandria LA 71303-2322 | |
| (318) 787-2708 | |
| (318) 787-2716 |
| Full Name | Mayfield Advanced Medical, Llc |
|---|---|
| Speciality | General Practice |
| Location | 5419 Jackson St Ext Ste B, Alexandria, Louisiana |
| Authorized Official Name and Position | Conrad Martin Taylor (OWNER) |
| Authorized Official Contact | 3187872708 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mayfield Advanced Medical, Llc 5419 Jackson St Ext Ste B Alexandria LA 71303-2322 Ph: (318) 787-2708 | Mayfield Advanced Medical, Llc 5419 Jackson St Ext Ste B Alexandria LA 71303-2322 Ph: (318) 787-2708 |
| NPI Number | 1710495627 |
|---|---|
| Provider Enumeration Date | 01/12/2018 |
| Last Update Date | 01/12/2018 |
| Medicare PECOS PAC ID | 8921356684 |
|---|---|
| Medicare Enrollment ID | O20180813001645 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710495627 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Samuel R Mayfield |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1912298472 PECOS PAC ID: 5698943678 Enrollment ID: I20110718000600 |
| Provider Name | Conrad Martin Taylor |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1104125228 PECOS PAC ID: 6507034584 Enrollment ID: I20110802000283 |
| Provider Name | Kirsten Van Mol |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124546478 PECOS PAC ID: 5597031682 Enrollment ID: I20171017002238 |
| Provider Name | Anthony Aguilar |
|---|---|
| Provider Type | Practitioner - Chiropractic |
| Provider Identifiers | NPI Number: 1417665092 PECOS PAC ID: 8628446267 Enrollment ID: I20231204002917 |
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