Provider Demographics
NPI:1962576710
Name:PAYNE & RICE CLINIC, INC.
Entity type:Organization
Organization Name:PAYNE & RICE CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-473-2278
Mailing Address - Street 1:116 SW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:CHECOTAH
Mailing Address - State:OK
Mailing Address - Zip Code:74426-3602
Mailing Address - Country:US
Mailing Address - Phone:918-473-2278
Mailing Address - Fax:918-473-5999
Practice Address - Street 1:116 SW 2ND ST
Practice Address - Street 2:
Practice Address - City:CHECOTAH
Practice Address - State:OK
Practice Address - Zip Code:74426-3602
Practice Address - Country:US
Practice Address - Phone:918-473-2278
Practice Address - Fax:918-473-5999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK300522044Medicare ID - Type Unspecified