Provider Demographics
NPI:1528537057
Name:CAYCE MEDICAL SPA, INC
Entity Type:Organization
Organization Name:CAYCE MEDICAL SPA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CANDYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:573-234-6930
Mailing Address - Street 1:2001 CORONA RD STE 201
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-5924
Mailing Address - Country:US
Mailing Address - Phone:573-234-6930
Mailing Address - Fax:
Practice Address - Street 1:2001 CORONA RD STE 201
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5924
Practice Address - Country:US
Practice Address - Phone:573-234-6930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty