Provider Demographics
NPI:1063766012
Name:MAG MEDICAL
Entity type:Organization
Organization Name:MAG MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:606-672-1144
Mailing Address - Street 1:21154 HWY 421
Mailing Address - Street 2:
Mailing Address - City:HYDEN
Mailing Address - State:KY
Mailing Address - Zip Code:41749
Mailing Address - Country:US
Mailing Address - Phone:606-672-1144
Mailing Address - Fax:606-672-1145
Practice Address - Street 1:21154 HWY 421
Practice Address - Street 2:
Practice Address - City:HYDEN
Practice Address - State:KY
Practice Address - Zip Code:41749
Practice Address - Country:US
Practice Address - Phone:606-672-1144
Practice Address - Fax:606-672-1145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006479363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty