Provider Demographics
NPI:1457518193
Name:STEPHEN L PAYNE, MD, PC
Entity type:Organization
Organization Name:STEPHEN L PAYNE, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-458-0112
Mailing Address - Street 1:227 ADAMS ROAD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01267-2932
Mailing Address - Country:US
Mailing Address - Phone:413-458-0112
Mailing Address - Fax:413-458-5114
Practice Address - Street 1:227 ADAMS ROAD
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:MA
Practice Address - Zip Code:01267-2932
Practice Address - Country:US
Practice Address - Phone:413-458-0112
Practice Address - Fax:413-458-5114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA58444207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3116247Medicaid
DO0293OtherRAILROAD MEDICARE
J30129OtherBLUE CROSS BLUE SHIELD
MA110082118AMedicaid
J30129OtherBLUE CROSS BLUE SHIELD
E16849Medicare UPIN
MA110082118AMedicaid