Provider Demographics
NPI:1609252519
Name:PAYNE FREE LIVING, LLC
Entity Type:Organization
Organization Name:PAYNE FREE LIVING, LLC
Other - Org Name:PAYNE'S MIRACLE EAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-984-5250
Mailing Address - Street 1:PO BOX 8745
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS VILLAGE
Mailing Address - State:AR
Mailing Address - Zip Code:71910-8745
Mailing Address - Country:US
Mailing Address - Phone:501-984-5250
Mailing Address - Fax:501-984-5973
Practice Address - Street 1:4585 N HIGHWAY 7 STE 12
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS VILLAGE
Practice Address - State:AR
Practice Address - Zip Code:71909-8202
Practice Address - Country:US
Practice Address - Phone:501-984-5250
Practice Address - Fax:501-984-5973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-03
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment