Provider Demographics
NPI:1386815876
Name:PAYNE FAMILY MEDICINE INC
Entity type:Organization
Organization Name:PAYNE FAMILY MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MERCEDES
Authorized Official - Middle Name:VALENCIA
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-845-4139
Mailing Address - Street 1:2201 CHARLES ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3378
Mailing Address - Country:US
Mailing Address - Phone:540-845-4139
Mailing Address - Fax:
Practice Address - Street 1:2201 CHARLES ST
Practice Address - Street 2:SUITE 102
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3378
Practice Address - Country:US
Practice Address - Phone:540-845-4139
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0021550280207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2276306OtherCIGNA
VA7724414OtherAETNA
VAP00663222Medicare PIN
VA2276306OtherCIGNA
VA7724414OtherAETNA