Provider Demographics
NPI:1023848637
Name:PAYNE FAMILY HEALTHCARE INC
Entity type:Organization
Organization Name:PAYNE FAMILY HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:951-543-7712
Mailing Address - Street 1:19069 VAN BUREN BLVD STE 114
Mailing Address - Street 2:PMB 491
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-2548
Mailing Address - Country:US
Mailing Address - Phone:951-543-7712
Mailing Address - Fax:
Practice Address - Street 1:351 CORPORATE TERRACE CIR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-6028
Practice Address - Country:US
Practice Address - Phone:951-543-7712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-07
Last Update Date:2024-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty