| Blaine Payne, Inc | |
|
180 Nw Haynes St Madison FL 32340-2010 | |
| (850) 973-1215 | |
| (866) 923-4163 |
| Full Name | Blaine Payne, Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 180 Nw Haynes St, Madison, Florida |
| Authorized Official Name and Position | Tammey Revels (BUSINESS MANAGER) |
| Authorized Official Contact | 8509731215 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blaine Payne, Inc Po Box 185 Madison FL 32341-0185 Ph: () - | Blaine Payne, Inc 180 Nw Haynes St Madison FL 32340-2010 Ph: (850) 973-1215 |
| NPI Number | 1770943409 |
|---|---|
| Provider Enumeration Date | 02/23/2016 |
| Last Update Date | 06/30/2016 |
| Medicare PECOS PAC ID | 5597048363 |
|---|---|
| Medicare Enrollment ID | O20170202000766 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770943409 | NPI | - | NPPES |
| 37137 | Other | BCBS | |
| 272752800 | Medicaid | FL | |
| HUMANA | Other | HUMANA | |
| SXJQY | Other | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QG0300X | Family Medicine - Geriatric Medicine | OS9255 (Florida) | Primary |
| Provider Name | Theresa B Payne |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306858956 PECOS PAC ID: 4486686557 Enrollment ID: I20050909000242 |
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