Provider Demographics
NPI:1891769683
Name:MAYFIELD PATHOLOGY SERVICES PSC
Entity type:Organization
Organization Name:MAYFIELD PATHOLOGY SERVICES PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:VILES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-251-4116
Mailing Address - Street 1:1029 MEDICAL CENTER CIRCLE
Mailing Address - Street 2:SUITE 405
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066
Mailing Address - Country:US
Mailing Address - Phone:270-251-4520
Mailing Address - Fax:270-251-4521
Practice Address - Street 1:1099 MEDICAL CENTER CIRCLE
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066
Practice Address - Country:US
Practice Address - Phone:270-251-4520
Practice Address - Fax:270-251-4521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY200247207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY37000213Medicaid
4015401Medicare ID - Type Unspecified
X54025Medicare UPIN