Provider Demographics
NPI:1053447953
Name:JOHN H PAYNE ASSOC INC
Entity Type:Organization
Organization Name:JOHN H PAYNE ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-872-1557
Mailing Address - Street 1:2020 WEST 86TH STREET
Mailing Address - Street 2:101
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260
Mailing Address - Country:US
Mailing Address - Phone:317-872-1557
Mailing Address - Fax:317-872-6042
Practice Address - Street 1:2020 WEST 86TH ST
Practice Address - Street 2:101
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260
Practice Address - Country:US
Practice Address - Phone:317-872-1557
Practice Address - Fax:317-872-6042
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN H PAYNE ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-26
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100153260AMedicaid
IN100153260AMedicaid